St. John-in-the-Wilderness Anglican Church Presents the

BLUEWATER TRIATHLON and  DUATHLON - Saturday, July 24, 2010

Entry Form:  Bluewater Triathlon and Duathlon

Entry Fee:  $50.00 per team or Triathlete or Duathlete for entries received July 16, 2010 or earlier.  $55.00 for entries received July 27, 2010 to race day. Insurance Fee (see  insurance):  $6.00 per triathlete, duathlete or each member of a team if you are not an OAT member ($12 for a two person team, $18 for a three person team). You will not be allowed to compete without insurance.   Please bring 1 can of food which will be donated to our local food bank.  Yes, you can register at the Friday night pasta party or race morning; however, we will not guarantee a T-shirt. We accept payment by cheque or cash.

Name______________________________________Birthday (D/M/Y)_____________

Address____________________________________City_______________________

Prov./State__________Postal/Zip____________Telephone_____________  Sex:    M   F

Age on Race Day________  T-Shirt Size(circle one):  S      M     L     XL      XXL

Check One:  Triathlon____   Duathlon____    Team Triathlon____  Team Duathlon____

Entry Fee(a)________             Insurance Fee(b)________            Total Fee(a+b) ______

(Plus 1 can of food to be donated to the local food bank)

Please note on this form any medical condition you have that our race doctor should know about. 

Teams:  please provide the above registration and medical information for each team member, indicating each member's event.  If you would like to assign a team name, please do this as well (they are usually fun).  In the absence of a team name we will use a team member's last name to post team results.

Please make cheques payable to:  "Bluewater Triathlon" and send them to 2472 Hamilton Road, Brights Grove, Ontario, Canada, N0N 1C0.

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