REGISTRATION FORM

All entrants must show USAT membership card at check-in or purchase a one-day membership for $10. Each entrant must sign a separate USAT waiver (on back.)

NAME:__________________________________D.O.B. ____/____/____Age on 12/31/08_____

ADDRESS:____________________________________________________________________

CITY:_________________________________STATE:_____ZIP:________________________

TELEPHONE:______________________________E-MAIL:____________________________

SEX: M F USAT#:______________________COURSE: Long Short

TEAM: ___Male ___Female ___Mixed ___Masters Male ___Masters Female ___Masters Mixed

Name USAT#

TEAM SWIMMER:____________________________________________________________________

TEAM BIKER:_______________________________________________________________________

TEAM RUNNER:_____________________________________________________________________

FEES ENCLOSED:

Individual Triathlon (long or short) $60 _______________________

Team $75 _______________________

Late Fee (>7/24 per entrant) $5 _______________________

USAT (per person) $10 _______________________

Total _______________________

Make checks payable to Ozark Racing Systems. Mail to 3057 S. Fremont, Springfield, MO 65804.

Waiver (Separate USAT waiver on back must be signed.)

I hereby release and agree to indemnify and save harmless anyone affiliated with Ridge runner Sports, Ozark Racing Systems, City Utilities, and all sponsors associated with this event from any and all claims of any nature for injury or loss that may result from such participation in this event.

Athletes signature Parent’s signature if under 18 yrs. of age