Chattanooga Dam Triathlon Application

Official Entry Form
Chattanooga's Dam Triathlon
Sunday June 27, 2004
EARLY REGISTRATION EXTENDED!

Early entry registration for the 2004 Dam Triathlon, Sunday, June 27, 2004 is being extended to June 20, 2004. All registration through Active.com and mailed applications postmarked before midnight June 20, 2004 will be $55 for Individual (Age Group, Athena, and Clydesdale) and $120 for Relay Teams. Registration after June 20, 2004 will $75 for Individuals (Age Group, Athena, and Clydesdale) and $150 for Relay Team and will only be available at packet pick-up on Saturday, June 26, 2004 at Chattanooga State. There is no race day registration. To register today at Active.com, click here Dam Triathlon Registration

Make checks payable to: Chattanooga Track Club
Mail to: Chattanooga's Dam Triathlon
303 Amhurst Ave.
Chattanooga, TN 37411

Official Use

Check Applicable Boxes	Before 4/30	4/30 - 6/20	After 6/20
Age Group	$55	$55	$75	+ $ __________
Clydesdale or Athena (circle one)	$55	$55	$75	+ $ __________
Relay Team Member	$120	$120	$150	+ $ __________
USAT Single Event license fee (if not annual member)	add $9.00	add $9.00	add $9.00	+ $ __________
Chattanooga Track Club Members (pre-registered only)	deduct $5.00	deduct $5.00	deduct $5.00	- $ __________
				Total $ ________

Entry Fees are Non-Refundable
               Relay Team members must complete separate entry forms listing which event each team member will participate in and submit together with full payment.
               This is an USAT Sancioned Event - All entrants are required to have an annual USAT license or purchase a one day license for $9. Only one member of a relay team needs to have a USAT license. Annual licenses may be purchased for $30. Annual members must present their license at packet pick-up or purchase a one day license for $9. No Exceptions.
                Important: You are required to read and sign an Acknowledgment Waiver and Release from Liability Form and TVA Waiver at packet pick-up. Participants under 18 years old must have a parent or guardian sign the waivers. USAT now requires that entrants bring a photo id with them when they are registering.

Please Print Clearly
First Name _______________________________ Last Name _____________________________

Age (on 6/27/04) _____ Date of Birth ___________ Sex _____ T-Shirt Size S M L XL XXL

Address ________________________________________________________________________

City/State/Zip _______________________________ Email Address _________________________

Daytime Phone ( ) _____________________ Evening Phone ( ) _____________________

USAT License Number ________________________ ChampionChip Number _________________

Please list: _______________________________________________________________________

Emergency Contact: ______________________________ Phone: ( ) _____________________

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