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Louisville Landsharks Triathlon Name(last)____________________________________(first)______________________ Age on Race Day________Birthdate_______________________Sex______________ Address_________________________________________________________________ City____________________________________State___________Zip______________ Phone( )______________________________Email_________________________ USAT Number_________________________Shirt Size (circle one) S M L XL Fee: (circle one) before July 30 before Aug 30 Aug 30 through race day Individual $60 $65 $ 70 Relay Member $35 $40 $45 All non USAT members must add $10 Louisville Landshark members receive a 50% DISCOUNT Signature (parent or guardian if under 18)___________________________________Date_________________In consideration of the acceptance of my entry in the Taylorsville Lake International Distance Triathlon I hereby agree to comply with all the rules and regulations and event instructions of the Taylorsville Lake International Distance Triathlon and its directors. 2. For myself, my executors administrators, heirs, next of kin, successors and assigns, I HEREBY:(a)waive and release any and all claims that I may have against the Taylorsville Lake International Distance Triathlon, its event committee, their officers, directors, members, volunteers, employees, sponsors or any one or more of them their executors, administrators, heirs, next of kin, successors or assigns ("their releases") including any and all claims for damage caused by the negligence of any them, arising out of my participation in the event and its related activities, together with any cost, including attorney’s fees, that may be incurred as a result of any such claim whether valid or not, and (b)indemnify and hold harmless the releases and each of them against any such claim that I or my guest or any one or more of my or their executors, administrators, heirs, next of kin, successors or assigns may have or assert and against any cost including attorney’s fees with respect therto. 3. I hereby acknowledge that I have sole responsibility for my personal possessions and athletic equipment during the event and its related activities. 4. I hereby acknowledge that participation in this event carries with it potential hazard. I therefore release the Taylorsville Lake International Distance Triathlon, its event committee, their officers, directors, members, volunteers, employees or sponsors of any liability resulting from injury or death during the event and its related activities. 5. I hereby attest and verify that I am physically fit and have sufficiently trained for this competition and that my physical condition has been verified by a licensed medical doctor. 6. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident and/or illness during the event. 7. I hereby agree that in the event of race cancellation due to storm, rain, inclement seas, or weather, winds or other "Acts of God" conditions, my enrollment fee shall be non-refundable. Signature(Parent or Guardian if under 18)________________________________Date_______________________ Checks payable to Headfirst Performance Services and Mail to:7024 Buckcreek Rd., Finchville, KY 40022 |
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