CLEVEDON MARINE LAKE AQUATHLON
SUNDAY 4TH JULY 2010 – 10.30 START
BRITISH TRI RULES, AFFILIATED TO ASA & BLDSA
First name: ……………………………….…...........................................................................................................………………
Surname: ……………………………………………............................................................................………………………...
Address: …………………………………………………………………………………………………………………
Postcode: ……………………………………………..……... Telephone: ……………………………………………..
Email: (please print clearly) ……………………………………………………………….……………………………
Date of birth: ……………………………………………..……... Age: …………………………………. Male/Female
Medical details we should be aware of (e.g. Asthma): …………………………………………………………………..
Team name (if applicable):……………………………………………………………………………………………….
(Each member of a team must submit a completed entry form)
Category:( (AGE AS AT 31ST DECEMBER 2010)
Any mixed age or gender for the team event - please circle
Junior(12-16) Senior(17-39) veteran(40+)
Male Female Team (+ circle other info.)
Please circle the distance you wish to enter:
Swim 400m/Run 3k Swim 800m?Run 6kmm
Entry Fee: Juniors = £ 8.00
Seniors & Veterans = £14.00
Team = £20.00
ASA member = £ 2.00 reduction
Enteries will be accepted on the day = £ 2.00 per person extra (Latest entry time will be 9.50am)
Declaration
I declare that I will abide by the regulations governed by the organisers and accept that the event organisers and their associates are not liable for any loss, damage, claim or expense which may arise as a consequence of my participation in this event/these events. I agree to abide by the Amateur Swimming Association rules, copies of which are available at http://www.amateurswimmingassociation.org
I am of good health and compete at my own risk.
Signed: ………………………………………………………………….. Date: …………………………………………
Parental/Guardian Agreement: (for children under the age of 18)
Declaration as above and I agree to my child competing and I declare that I, or another adult will be present during the event.
Signed: ……………………………………………………………………….. Date: …………………………………..
Print Name: ………………………………………………………………………………………………………………
Consent for Photographs/Video (For children under the age of 18)
Photographs may be taken at the Clevedon Aquathlon by local press and other participants / supporters.
The photographs may be used by the event organisers for publicity material such as press releases, TV, media and promotional displays.
I hereby grant Clevedon Aquathlon organisers the absolute right to use images resulting from photography/video at the event. This includes any reproductions or adaptions of the images for all general publicity purposes.
Signature of Participant ………………………………………………… Date: …………………………........
Signature of Parent/Guardian ………………………………………….. Date:…………………………………
Cheques should be made payable to ‘MARLENS’ and received with the entry form by 26th June 2010 to:
Jennifer Ellis, 5, Tennyson Avenue, Clevedon, North Somerset. BS21 7UQ
Please note – This entry form provides membership category ‘C’ of CASC
Confirmation of entry will be sent by email or please send a SAE
ORGANISED BY CLEVEDON AMATEUR SWIMMING CLUB AND MARLENS