Shoe Clinic MTB Duathlon Series Race 1

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Who are you registering? Choose one Yourself Team

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 2021 2020 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    Gender -- Male Female   Phone #   Address   Emergency contact name   Emergency phone #   Distance Choose one Long Duathlon Short Duathlon   Category Choose one 16-19 20-29 30-39 40-49 50-59 60-69 70+ Team U16 Choose one 16-19 20-29 30-39 40-49 50-59 60-69 70+ Team U16   Event entry fee 20.00 NZD

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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver I/We accept that triathlon, duathlon and multisport including swimming, kayaking, cycling, running and walking are inherently dangerous and that accidents can occur that may result in serious injury and/or death and/or property damage. I/We agree to compete at my/our own risk and waive liability against the race organisers or any associated parties for any personal injury, loss of personal equipment, or damage to third party property that may result as a consequence of my/our involvement in this event. I agree to abide by the race rules and entry requirements, and accept any decisions made by the race organisers as final. I/We agree to the results and my/our photos being used for promotion and I/We agree that the information collected with this entry may be held by the organisers and/or sponsors and used to provide me/us with information on future triathlon, duathlon, multisport or sporting events. I accept the terms of the waiver Name of parent or guardian who approves this activity