Greenbanks Industrial Twilight Aquathon

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Team name   First name   Last name   Email address   Date of birth DD 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31    MM 01 02 03 04 05 06 07 08 09 10 11 12       YYYY 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920    Gender -- Male Female   Phone #   Address   Emergency contact name   Emergency phone #   Distance Choose one Enticer: 500m | 2.5km Team Enticer: 500m | 2.5k Sprint: 1km | 5km Team Sprint: 1km | 5km   Age Group Categories Choose one Junior Senior Veteran Choose one Junior Senior Veteran Choose one Junior Senior Veteran Choose one Junior Senior Veteran   Event entry fee TBD

Are you a Triathlon Australia member? NoYes -10.00 AUD If TA member, enter your membership number Are you new? Can we help you prior to the race with setting up transition? NoYes

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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver All competitors must read and sign this waiver form. Competitors under 18 years must have a parent or guardian sign on their behalf. Declaration to be signed by all competitors: In consideration of and as a condition of acceptance of my entry in the abovementioned race for myself, my respective heirs, executors and administrators, I hereby waive all and any claim, right or cause of action for which I, my respective heirs, executors and administrators might otherwise have for or arising out of: (i) Loss of life or injury, damage or loss of any description whatsoever caused including negligence of any person, corporation or body referred to below, suffered or sustained in the course of, consequent upon, or accidental to my entry or participation in the said event and, (ii) Any publication, or in the use and form of media whatsoever, of my name, photograph, images or activities in, or incidental to, my entry participation in the said event and whether for advertising or otherwise. The above release and discharge shall be and operate separately in favour of all persons, corporations and bodies involved, or otherwise engaged in promoting or staging the said event and the servants, agents, representatives, and officers of all and any of them and includes but is not limited to, the Race Organiser and their members, Triathlon South, Triathlon Australia, state/territory Triathlon Associations and their representatives, the Police, city/town officials and marshals, Life Saving officials/guards, medical and paramedial practitioners, and shall operate whether or not the loss, injury or damage is attributable to the act of neglect of any one or more of them. I have read, and am familiar with, the safety and medical aspects of participation in triathlons and will abide by these requirements. I accept the terms of the waiver Name of parent or guardian who approves this activity