Ranui Farm Park

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Dry Triathlon Entry Form

Use this form please whether you entering as an individual or a team.

Team Name: *

Team Leader: *

Team Leader gender: *

Team Leader age: *

Home Address: *

Telephone Number (please add area code): *

Email Address: *

Team Member 2 Name:

Team Member 2 gender:

Team Member 2 age:

Team Member 3 Name:

Team Member 3 gender:

Team Member 3 age:

Entry Fee Payment Method: *

Date of competition: *

6th May

Indemnity / Declaration - Read the conditions below: *

Decline

The members listed by name above all agree to abide by and comply with the rules, regulations and instructions of this event as given by the organisers and landowners and accept their decisions as final and binding.
We attest that we are sufficiently fit to participate in this event and we are aware of the risks involved and collectively hereby exempt the organisers and other event participants from any liability for damage or injury that may occur to ourselves or our property. Submission of this form constitutes acceptance of all of the aforegoing.

Ranui Farm Park gratefully acknowledges support from the following sponsors:

Scallywaggs Kindergarten & Care	Riddifords Sportsworld	Bike ‘n’ Mow Ltd
9 Russell Street, Waipukurau. 06 8587404 www.scallywaggs.co.nz	81 Ruataniwha Street, Waipukurau. 06 8589142 sports.world@xtra.co.nz	57 Ruataniwha Street, Waipawa. 06 8578442 bikenmow@clear.net.nz