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, August 4th. "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 2009 Wausau Triathlon
or comparable
triathlon. Individual Long course only.) Limited to 30.
Number of consecutive years in the Wausau Triathlon including 2010:
____
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, August 4th.
In-person or
mail-in registrations will be
accepted until 6:00 PM on Friday, August 6th.