DQ Events Universal Printable application

DQ Events Series		PRE-REGISTRATION
As a value-added service to our athletes, DQ Events proudly participates in an innovative Registration Fee Reimbursement plan through 365Competitors, LLC. This program entitles all race participants to a full refund of their registration fee should they become ill or injured and unable to race. Click on the 365Competitors logo for specifics on coverage. You may opt out of this coverage and deduct $5 from the registration fee
			FEE		CATEGORY
			TRI	DU/ Aqua	AGE GROUP (Age on Race Day)	Clydesdale/Athena (Check if applicable)	Fee
	Hammonton Recreation Department Sprint Triathlon 1/4 mile swim/2 mile run, 12 mile bike, 3 mile run Saturday - May 26, 2012 - 7:45 am	Individual by 5/20 5/20-5//25 Team USAT 1-day	$70 $75 $95 $12	$60 $65 $65 $12	____	____	____ ____
	Belleplain Triathlon/Duathlon/Aqua in Cape May County 1/4 mile swim/2 mile run, 15 mile bike, 5k run Sunday -June 10, 2012 - 8:00 am	Individual By 6/2 6/2-6/8 Team USAT 1-day	$70 $75 $95 $12	$60 $65 $65 $12	____	____	____ ____
	Parvin State Park Sprint Triathlon and Duathlon 1/4 mile swim/2 mile run, 12 mile bike, 5k run Saturday - June 16, 2012 - 8:00 am	Individual By 6/9 6/9-6/17 Team USAT 1-day	$70 $75 $95 $12	$60 $65 $65 $12	____	____	____
	Splash and Dash Swim/Run Duathlon 1/4 mile swim, 5k run Wednesday - July 11, 2012 - 7:00 pm *Note not covered by 365 so don't deduct $5	Individual By 7/4 7/4-7/10 Team By 7/6		$30 $35 $50	____	____	____ ____
	Vincentown Sprint Triathlon/Duathlon/Aqua 1/4 mile swim/2 mile run, 15 mile bike, 5k run Saturday - July 7, 2012 - 8:00 am	Individual By 7/1 7/1-7/6 Team USAT 1-day	$70 $75 $95 $12	$60 $65 $65 $12	____	____	____
	Tri/Du for Autism presented by Belmar, Lake Como and Spring Lake 1/4 mile swim/2mile run, 10 mile bike, 5k run Sunday Aug 5, 2012- 7:00 am	Individual By 7/29 7/29-8/4 Team USAT 1-day	$75 $90 $110 $12	$65 $80 $80 $12	____	____	____ ____
	Presidential Lakes Olympic Challenge Triathlon/Duathlon in the Pines Olympic - 1500 meter swim/5k run, 40k bike, 10k run Surday -Aug 12, 2012 - 7:30 am	Individual By 8/5 8/5-8/11 Team USAT 1-day	$90 $95 $125 $12	$80 $85 $95 $12	____	____	____
	Presidential Lakes Sprint Triathlon Sprint - 1/4 mile swim, 11 mile bike, 5k run Surday -Aug 12, 2012 - 8:00 am	Individual By 8/5 8/5-8/11 Team USAT 1-day	$70 $75 $95 $12		____	____	____
	2nd Annual Medford Lakes Coloney Triathlon 1/4 mile swim, 10 mile bike, 3 mile run Sunday -Aug 26, 2012 - 7:45 am	Individual By 8/19 8/19-8/25 Team USAT 1-day	$70 $75 $95 $12		_____	_____	____ ____
	DQ Triathlon at Marlton Lakes 1/4 mile swim, 11 mile bike, 3 mile run Saturday -Sept 1, 2012 - 7:45 am	Individual By 6/15 6/15-8/31 Team USAT 1-day	$70 $85 $95 $12		_____	_____	____ ____
	Shoreman 1/2 Distance Triathon/Aqua 1.2 mile swim, 56 mile bike, 13.1 mile run Saturday - September 8, 2012 - 7:00 am	Individual Early Bird by 2/29 3/1-8/31 9/1- 9/8 Team USAT 1-day	$130 $155 $180 $155 $12	$105 $130 $155 $12	____	____	____ ____
	Treasure Island Triathlon 1/4 mile swim/1.5 mile run, 10.5 mile bike, 3 miles run	Individual By Team USAT 1-day	$ $ $ $12	$ $ $ $12	____	____	____ ____
	Long Beach Island Annual Tri/Du 1/4 mile swim or 1.5 mile run, 10 mile bike, 5k run Sunday - September 16, 2012 - 7:40 am	Individual By 9/9 9/9-9/15 Team USAT 1-day	$70 $85 $95 $12	$60 $75 $65 $12	____	____	____ ____
	EOS Triathlon/Duathlon/Aqua at Island Beach State Park 1/4 mile swim/2mile run, 10 mile bike, 5k run Sunday - October 7, 2012 - 8:30 am (Includes $5 park entrance fee)	Individual By 9/30 9/30-10/6 Team USAT 1-day	$70 $75 $105 $12	$60 $65 $75 $12	____	____	____ ____
Number of Races Entered ____ Total Fees ____

Waiver to be signed on Race Day Click to print waiver

As a value-added service to our athletes, DQ Events proudly participates in an innovative Registration Fee Reimbursement plan through 365Competitors, LLC. This program entitles all race participants to a full refund of their registration fee should they become ill or injured and unable to race. Click on the 365Competitors logo for specifics on coverage. You may opt out of this coverage and deduct $5 from the registration fee (except the splash and dash the insurance is not offered for this event)

Please Select Race(s)

___ Hammonton ___ Belleplain ___ Parvin ___ Splash and Dash ____ Vincentown

___ Autism ___ Presidential Olympic ___ Presidential Sprint ___ Medford Lakes ____ Marlton

___ Shoreman Half ___ LBI ___ Treasure Island ___ Dottie's House End of Season

Name _____________________________________________________

Address ___________________________________________________

City _________________________________________________ State _____ Zip _____

Sex _____ Phone ____________________________________________

E-mail Address ______________________________________________

T-Shirt Size ___M ___L ___XL Date of Birth _______ Tri Fed Number _________________

Relay Teams (must fill out 1 form for each member of the team and send them together)

___Male Team ___Female Team ___Co-ed Team

___Team Swimmer ___Biker ___Runner

Make Checks payable to: DQ Events (Please print entire page and mail with payment)

Mail To: DQ Events

PO Box 555

Collingswood, NJ 08108

Races Held Rain or Shine - Event promoters have the right to alter events if dictated by weather or other conditions

No entry fee or portion of entry fee will be refunded, transferred or credited