PACIFIC CREST OLYMPIC TRIATHLON
& DUATHLON Entry Form

Sunday, June 24, 2012 - 9:00AM
Wickiup Reservoir to Sunriver, Oregon
TRI - 1.5K Swim, 28-Mile Bike, 10K Run
DU - 28-Mile Bike, 10K Run

Web site: www.racecenter.com/pacificcrest
Email: events@racecenter.com


*TRI NorthWest Ranked Event

Official Use Only


The Pacific Crest multisport events are under Special Use permit from the Deschutes National Forest.

Instructions
> Type in your information in the blanks provided.
> Print entry form & SIGN WAIVER (Entry will not be accepted without the signed waiver)
> Make Checks Payable to:
PC Olympic

Mail to:
AA Sports, Ltd.
4836 SW Western Ave.
Beaverton, OR 97005


Event (Choose One)

NOTE: This race is limited to the 1000 bikes (athletes)
ENTRY FEES ARE NON-REFUNDABLE / NON-TRANSFERABLE


Individual
(ENTRY FEES INCLUDE: Commemorative T-shirt, Finisher medal, & Post Race Food)


Relay - Two or Three Person (EACH PERSON MUST FILL OUT SEPARATE ENTRY FORM & ALL MUST BE MAILED IN TOGETHER)
(ENTRY FEES INCLUDE: Commemorative T-shirt, Finisher medal, & Post Race Food)

First Name / MI / Last Name

Street Address


City

State/Province

Zip/Postal Code

Birthdate - mm/dd/yy


Age

Gender

Phone

Email

Division (Individual)

Special Divisions (Applies to Individuals ONLY)

RELAY MUST COMPLETE*
* Team Name (20 characters or less)

* Triathlon Relay Division (TRI-Combined three ages; DU-Combined two ages)

Swimmer

Biker

Runner

T-Shirt Size (included with entry fee)

I WOULD LIKE TO RESERVE A BUS TICKET TO THE LAKE

If Bus Ticket Purchased, please indicate the time that you would prefer to go to the lake (Final schedule will be based on first come first served)

TRI NorthWest Membership #
(if applicable - deduct $10.00 if a member)

Check#

Amount Enclosed


WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
OFFICIAL WAIVER: I acknowledge that a Multi-Sport Event is an extreme test of a person's physical and mental limits and carries with it the potential for death, series injury, and property loss. I HEREBY ASSUME THE RISKS OF PARTICIPATING IN THIS EVENT. I certify that I am capable of completing all disciplines of the event, and that I am physically fit and that I have sufficiently trained. I agree to abide by the competitive rules. I hereby take the following action for myself, my executors, administrators, heirs, next to kin, successors and assigns, or anyone else who might claim or sue on my behalf, and I hereby waive, release and discharge from any and all claims, losses, or liabilities for death, personal injury, partial or permanent disability, property damage, medical or hospital bills, or theft which may arise out of or relate to my participation in this event. I agree not to sue, and to hold harmless any and all persons, sponsors, volunteers, participants or government agencies for any and all claims or liabilities that I have waived, released or discharges herein. I further agree to return the timing Chip that is been issued to me or to pay a $30 replacement charge. ENTRY FEES ARE NON-REFUNDABLE.

Type Full Name


Signature X ___________________________________________________________________
(Signature of Parent or Legal Guardian if participant is under the age of 18)

Date________________________________________