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Cromwell Summer Series Entry Form:

2012 Goldfields Jet Lake Dunstan Triathlon and Duathlon

I wish to participate in the 2012 Goldfields Jet Lake Dunstan Triathlon and Duathlon

Online entries close on 28th December 2011. Late entries can be made on the day of the event.

Competitor Information

First Name:
Surname:
Address:
City:
Phone:
Email:
(For Summer Series only)
Section:
Category:

Team Name:
Member 1:
Member 2:
Member 3:
Total:



Risk Disclosure Acknowledgement: In entering the 2012 Goldfields Jet Lake Dunstan Triathlon and Duathlon event I understand there are risk involved in the activities I will be undertaking. I also understand that an unpredictable or uncontrollable event may occur that could possibly cause me serious harm or death. I am aware of the implications of my voluntary participation and the consequences should I ignore the organisers 'Safety Management System' , 'Entry Form' and briefing, including procedures and directions regarding the use of any safety equipment. I acknowledge that the organisers will take all reasonable and practicable steps to keep me safe while I am involved in the event. However, I accept full responsibility for my own actions or inaction. I allow sponsors / organisers to use my name and/or photograph for promotional purposes.
I have read and understood the Risk Disclosure above:


Additional Information

Yes, I would like to receive a Ground Effect catalogue in the mail and go in the draw to win $250 worth of kit!
I wish to receive other sponsors' information