Wausau, WI 54403. Include a legal size, self-addressed, stamped envelope for confirmation information.
On line registration available at www.active.com for an additional processing fee
On-line registrations will not be accepted after 10:00 PM,
Wednesday, July 29th. "Online Registration Powered by Active.com"
PLEASE PRINT CLEARLY:
Last Name_________________________________ First Name
____________________________________
Street Address_________________________________________________________
Apt. #________________
City_________________________________________________
State
______________ Zip ___________
Birth Date ______________________________ Email Address:
___________________________________
COURSE: (Circle) Long Short
T-Shirt Size: (Circle) S M L XL XXL
(size not guaranteed)
Team Name_________________________________________________________
Phone # ( )
_______________________________
[ ] Check if you want to be considered for the Championship
Division (Top 15 placing in 2008 Wausau Triathlon
or comparable
triathlon. Individual Long course only.) Limited to 30.
Number of consecutive years in the Wausau Triathlon including 2009:
____
I hereby for myself and heirs, personal representatives and assigns, waive
and release all rights and
claims for damages I may have against YMCA, Marathon County, the City of
Wausau, other sponsors
and affiliates of the Wausau Triathlon, and/or their respective agents,
representatives, successors and
assignees, for any and all injuries which may be suffered by me in
connection with my voluntary
participation in the August 1, 2009 YMCA triathlon. I am physically
able to compete in the race(s)
checked above and agree to compete at my own risk.
________________________________________________________________________________________________
Signature (Parent or Guardian must sign for participants under
18 years of age).
Amount Enclosed $______________________
MC/VISA # _______________________________
Exp.Date:____/____
Last 3 digits on back of card in signature box _______
** NO SAME DAY REGISTRATION **
On-line registrations will not be available
after 10:00 PM on Wednesday, July 29th.
In-person or
mail-in registrations will be
accepted until 6:00 PM on Friday, July 31st.