Ilen Duathalon

Skibbereen
SUNDAY 25thApril 2010
3.5 km Run/30 km Cycle/3.5 km Run

Registration Form

Please Fill Appropriate Boxes

RACE START TIME: 12 O’ClOCK

Individual Registration Team Registration (Teams of 2)
Full Name: Cyclist Name:
Email Address:
Postal Address: Postal Address:

Email Address: Runners Name:

Contact Number: Email Address:
Age on the
31/12/2009: Postal Address:
DOB:
Contact
Number(s):

Sex Category Male □ Female □

Age Category 16-19 □ Team Category Womens □
20-29 □ Mens □
30-39 □ Mixed □
40-49 □

50-59 □
T-Shirt Size T-Shirt Size
Team Team member
small □ member 1 2

medium □ small □ small □

large □ medium □ medium □

large □ large □
 Entries are open on the 1st of February 2010
Please ensure you enter before Sunday the 18th of April 2010
**NOTE: To ensure you get a t-shirt, entries need to be
received by Sunday 21st March 2010

Registration Sunday – 10.00 – 11.00

ENTRY FEES: € 30 / athlete

€ 40 / team(teams of 2)

I enclose herewith my entry fee of €_________

Cheques to be made payable to Skibbereen Rowing Club.
Please return to:-
Denise O’Neill, 57 The Mills, Skibbereen Co. Cork
For further info contact Denise on 086-1020978 or email
deniseskibb@yahoo.co.uk

Please sign the Race Proficiency declaration and disclaimer

below’(Both individuals and each member of a relay team must
sign)
Cycle / Run PROFICIENCY DECLARATION:

I, the competitor (see signature below) confirm that I:

• Have completed a continuous Duathalon run 3km run/cycle 30km/ 3km run or 1.30 hours of
training within 40 days of the event

• Understand All safety aspects of the race and safety procedures and my own limitations

• I am aware of the route, its length, the depth the direction of the course and any hazards.

• Understand and abide by the rules of the road.

Print Name (BLOCK): Signature _____________________

Date ______________
DECLARATION:
I agree and acknowledge that participation in or observation of sport could constitute a risk of serious injury to myself, including
permanent paralysis or death. I voluntarily and knowingly recognize, accept and assume this risk and warrants to the organisers
of this event and its Associates that I am physically fit and able to compete in this event without risking serious injury, including
permanent paralysis or death. Furthermore, I hereby release the Event Organizers, Skibbereen Rowing club, their Associates,
their Sponsors, Event Sponsors, officials and marshals from any liability arising from my participation in this event. I agree that
neither Skibbereen Rowing club nor its Associates shall be, nor be deemed to be, responsible or liable (whether in contract or in
tort or under any statute whatsoever), for any injury, illness or other mishap to myself or my property, sustained in, or arising
from or out of, or in any way directly or indirectly connected with this event.

Print Name (BLOCK): Signature _____________________

Date ______________
All competitors under the age of 18 must get this section of the form signed by a parent or guardian.
Print Name (BLOCK): _________________________
Signature of Parent/Guardian_________________________ Date: _____________________