Dartington Duathlon

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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   Team (optional club or team name) Choose one ARMY TRIATHLON ASSOCIATION BIKE CITY BOVEY VALLEY RUNNERS CCCP DARTMOUTH DARTMOUTH AAC DARTMOUTH AMATEUR ATHLETIC CLUB DSFRS TRI CLUB EAST CORNWALL HARRIERS ELIMENTS TRI CLUB EXETER TRI CLUB EXETER TRIATHLON CLUB FORDY RUNNERS FRAZER FREMINGTON TRAILBLAZERS GARY JOHNSON’S YELLOW ARMY GREENBOW RUNNING CLUB GS VECCHI HALDON TRAIL RUNNERS HERCULES WIMBLEDON HULL BARRACUDAS IMI GRIFFN ISCA HASH HOUSE HARRIERS KPR LONGRUN MEADOW PARKRUN LOOE PIONEERS RC MDCC MID DEVON TRIATHLON MIDLANDS MADNESS N/A NEWQUAY ROAD RUNNERS NEWTON ABBOT ATHLETICS CLUB NO CLUB NONE PH3 PLYMOUTH TRIATHLON PLYMOUTH TRIATHLON CLUB PURE ENDURANCE PURE ENDURANCE TRIATHLETES QUAYSIDE LEISURE KINGSBRIDGE ROYAL NAVY TRIATHLON SERPENTINE SID VALLEY CYCLE CLUB STORM TAMAR TROTTERS TAVISTOCK ATHLETICS CLUB TAVISTOCK TRIATHLON CLUB TEIGNBRIDGE TROTTERS TORBAY TRI TORBAY TRI CLUB TORBAY TRIATHLON CLUB TRAILBLAZERS TRI-LOGIC TRI-LOGIC CORNWALL TUNBRIDGE WELLS TRI CLUB UNIVERSITY OF EXETER TRIATHLON CLUB VEGAN RUNNERS WOODIES DEVON YOGI CYCLING Other     Club name Other     Phone #   Address   Emergency contact name   Emergency phone #   Choose race & distance Choose one GO TRI / Novice Sprint Distance Standard Distance   Choose age category Choose one GO TRI / Novice Choose one Junior (15-19) Senior (20-39) Vet 40 Vet 50 Vet 60 Choose one Junior (15-19) Senior (20-39) Vet 40 Vet 50 Vet 60   Event entry fee TBD

Want to purchase a T-shirt NoYes 9.95 GBP Want to purchase a technical t-shirt NoYes 11.95 GBP The left image shows the front View image T-shirt size Choose one Small mens Medium mens Large mens Extra large mens XS lady Small Lady Medium Lady Large Lady Are you a member of an affiliated running club or the trail running association?*  * NoYes   2.00 GBP

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