Saturday, November 7, 2015
ONE ENTRY PER FORM. THIS FORM MAY BE PHOTOCOPIED. PLEASE PRINT LEGIBLY AND USE BLUE OR BLACK INK ONLY.
Sprint Triathlon
Swim 0.5mi | Bike 15k | Run 3.1mi
I am registering for: (check one only) ■ Duathlon (Ages 12+) ■ Sprint Triathlon (Ages 12+) ■ Relay Sprint Triathlon (Ages 12+) ■ Relay Duathlon (Ages 12+) ■ 5K Run (Ages 8+)
Duathlon
2
0
1
5
Run 3.1mi | Bike 15k | Run 3.1mi Compete as an individual or part of a relay team!
Saturday, November 7, 2015
12/31/15
Avalon, California ENTRY FEES (Make checks payable to Renegade Racing) UNTIL 4/30 UNTIL 6/30 UNTIL 8/31 UNTIL 10/19 AFTER 10/19
Sprint Triathlon (Ages 12+) $80
$90
$100
$110
$120
$_______
$100 $110
$120
$130
$140
$_______
Duathlon (Ages 12+)
$80
$90
$100
$110
$120
$_______
Duathlon Relay
$100 $110
$120
$130
$140
$_______
$22
$28
$30
$35
$_______
Sprint Tri Relay
5K Run
(Ages 12+)
(Ages 12+)
(Ages 8+)
$25
$_______
USAT 1-Day License (Triathlon only) TRIATHLON
$12
RELAY
$12/per person
YOUTH (17 AND UNDER)
TOTAL AMOUNT ENCLOSED
Visa
MC
$10
$_______ T-Shirt Size ■ S
Am Ex Billing Zip Code
■M
■L
■ XL
■ Child’s M
■ Child’s S
CVV Number
Credit Card # _________________________________________ Exp. Date____________________________________________ Signature ___________________________________________ WAIVER
Check one:
SWIM BIKE RUN
By checking the box I agree to the terms within the USAT waiver. Copies of the waiver can be found on www.usatriathlon.org or by calling Renegade Racing at (949) 975-1812 for a mailed or faxed copy.
______________________________________________________ Signature of Participant (Signature of Parent or Guardian if under 18)
Date
RACE DAY EMERGENCY CONTACT ( ) ______________________________________________________ Name (Please Print)
Phone
12/31/15
T-Shirt Size ■ S
■M
■L
■ XL
■ Child’s M
■ Child’s S
ENTRY FEES ARE NON-REFUNDABLE AND NON-TRANSFERABLE. RACES HELD RAIN OR SHINE.
Check one:
SWIM BIKE RUN
MAIL TO:
17835 Sky Park Circle, Suite F, Irvine, CA 92614 949-975-1812 PHONE • 949-975-1814 FAX 12/31/15
T-Shirt Size ■ S
■M
■L
■ XL
■ Child’s M
■ Child’s S
Sprint Triathlon
Swim 0.5mi | Bike 15k | Run 3.1mi
I am registering for: (check one only) ■ Duathlon (Ages 12+) ■ Sprint Triathlon (Ages 12+) ■ Relay Sprint Triathlon (Ages 12+) ■ Relay Duathlon (Ages 12+) ■ 5K Run (Ages 8+)
Duathlon
2
0
1
5
Run 3.1mi | Bike 15k | Run 3.1mi Compete as an individual or part of a relay team!
Saturday, November 7, 2015
12/31/15
Avalon, California ENTRY FEES (Make checks payable to Renegade Racing) UNTIL 4/30 UNTIL 6/30 UNTIL 8/31 UNTIL 10/19 AFTER 10/19
Sprint Triathlon (Ages 12+) $80
$90
$100
$110
$120
$_______
$100 $110
$120
$130
$140
$_______
Duathlon (Ages 12+)
$80
$90
$100
$110
$120
$_______
Duathlon Relay
$100 $110
$120
$130
$140
$_______
$22
$28
$30
$35
$_______
Sprint Tri Relay
5K Run
(Ages 12+)
(Ages 12+)
(Ages 8+)
$25
$_______
USAT 1-Day License (Triathlon only) TRIATHLON
$12
RELAY
$12/per person
YOUTH (17 AND UNDER)
TOTAL AMOUNT ENCLOSED
Visa
MC
$10
$_______ T-Shirt Size ■ S
Am Ex Billing Zip Code
■M
■L
■ XL
■ Child’s M
■ Child’s S
CVV Number
Credit Card # _________________________________________ Exp. Date____________________________________________ Signature ___________________________________________ WAIVER
Check one:
SWIM BIKE RUN
By checking the box I agree to the terms within the USAT waiver. Copies of the waiver can be found on www.usatriathlon.org or by calling Renegade Racing at (949) 975-1812 for a mailed or faxed copy.
______________________________________________________ Signature of Participant (Signature of Parent or Guardian if under 18)
Date
RACE DAY EMERGENCY CONTACT ( ) ______________________________________________________ Name (Please Print)
Phone
12/31/15
T-Shirt Size ■ S
■M
■L
■ XL
■ Child’s M
■ Child’s S
ENTRY FEES ARE NON-REFUNDABLE AND NON-TRANSFERABLE. RACES HELD RAIN OR SHINE.
Check one:
SWIM BIKE RUN
MAIL TO:
17835 Sky Park Circle, Suite F, Irvine, CA 92614 949-975-1812 PHONE • 949-975-1814 FAX 12/31/15
T-Shirt Size ■ S
■M
■L
■ XL
■ Child’s M
■ Child’s S
