OFFICIAL ENTRY FORM, THE 25th ANNUAL TINMAN TRIATHLON
Send check and signed entry form to:
Tinman Triathlon
c/o Student Activities
600 E. 4th Street
Morris, MN 56267
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LAST NAME |
FIRST NAME |
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MAILING ADDRESS |
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CITY |
STATE |
ZIP CODE |
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MALE |
FEMALE |
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GENDER |
AGE |
DATE OF BIRTH |
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DIVISION:
INDIVIDUAL: ________
RELAY: ____ ALL MALE ____ALL FEMALE ____CO-ED ____UMM (current UMM student)
| ELITE HEAT: |
SWIM HEAT PLACEMENT |
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| If you plan to finish in 2 hours, 5 min. Check here: |
EXACT TIME: ( List Estimated 1100-yard Swim Time ) |
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| Under 17 min. |
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| 17 20 min. |
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| 20 23 min. |
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| 23 27 min. |
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| 27- 33 min. |
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| 33+ (if over 40 specify) | |||
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IN CASE OF EMERGENCY CONTACT |
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FULL NAME: |
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RELATIONSHIP: |
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FULL DAYTIME PHONE: |
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T-SHIRT SIZE |
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M |
L |
XL |
XXL |
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ADDITIONAL INFORMATION: |
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DAYTIME PHONE: |
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EMAIL: |
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RELAY TEAM NAME: |
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* EACH TEAM MEMBER MUST SUBMIT THEIR OWN ENTRY FORM * EACH TEAM MUST SUBMIT A TEAM NAME |
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RUNNER |
BIKER |
SWIMMER |
______ Please Check here if you are a UMM alumni.
ACCIDENT WAIVER AND RELEASE OF LIABILITY
I acknowledge that this athletic event is an extreme test of a person s physical and mental limits and carries with it the potential for death, serious injury and property loss. The risks include, but are not limited to, those caused by terrain, facilities, temperature, weather, condition of athletes, equipment, vehicular traffic, actions of other people including, but not limited to, participants, volunteers, spectators, coaches, event officials, and event monitors, and/or producers of the event, and lack of hydration. These risks are not only inherent to athletics, but are also present for volunteers. I hereby assume all the risks of participating &/or volunteering in this event
I certify that I am physically fit, have sufficiently trained for participation in the event, and have not been advised otherwise by a qualified medical person.
I acknowledge that this Accident Waiver and Release of Liability (AWRL) form will be used by the event holders, sponsors and organizers, in which I may participate and that it will govern my actions and the responsibilities at said event
In consideration of my application and permitting me to participate in this event, I hereby take action for myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) Waive, Release, and Discharge from any and all liability for my death, disability, personal injury, property damage, property theft, or actions of any kind which may hereafter accrue to me or my traveling to and from this event, THE FOLLOWING ENTITIES OR PERSONS: Regional Fitness Center, University of Minnesota Morris, City of Morris, County of Stevens, their directors, officers, employees, volunteers, representatives, and agents, the event holders, event sponsors, event directors, event volunteers; (B) Indemnify and Hold Harmless the entities or persons mentioned in this paragraph from any and all liabilities or claims made by other individuals or entities as a result of my actions during the Tinman Triathlon.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during the event.
I understand that at this event or related events I may be photographed. I agree to allow my photo, video or film likeness to be used for any legitimate purpose by the event holders, producers, sponsors, organizers, and/or assigns.
This AWRL shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.
I hereby certify that I have read this document; and, I understand its content.
Name:___________________________ Age:_______ Signature:____________________________ Date:___________
PARENT GUARDIAN WAIVER FOR MINORS (Under 18 years old)
The undersigned parent and natural guardian or legal guardian does hereby represent that he/she is, in fact, acting in such capacity and agrees to save and hold harmless and
indemnify each and all parties referred to above from all liability, loss, cost, claim, or damage whatsoever which may be imposed upon said parties becuase of any defect in or lack of such
capacity to so act and release said parties on behalf of the minor and the parents or legal guardian.
Name:_______________________________ Signature:_________________________________ Date:___________
Make checks payable to: UMM
Memo: Tinman Triathlon
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Postmarked on or before April 4th |
Through April 17th |
Race Day |
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Individual |
$25 |
$30 |
$35 |
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Individual UMM Student |
$15 |
$20 |
$25 |
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Team |
$50 |
$55 |
$60 |
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Team UMM Students |
$35 |
$40 |
$45 |
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FOR OFFICE USE ONLY |
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Payment Received Date: |
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Payment Amount: |
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Staff Initials: |
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