DQ Events Universal Printable application

DQ Events Series		PRE-REGISTRATION

			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 25, 2013 - 7:45 am	Individual by 5/19 5/19-5/24 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 15, 2013 - 8:00 am	Individual By 6/9 6/9-6/14 Team USAT 1-day	$70 $75 $95 $12	$60 $65 $65 $12	____	____	____
	Stafford Triathlon/Duathlon/AquaBike 1/4 mile swim,10 mile bike, 5k run Saturday, June 22, 2013	Individual By 6/15 6/15-21 Team	$70 $75 $95	$60 $65 $65	____	____	____ ____
	Vincentown Sprint Triathlon/Duathlon/Aqua 1/4 mile swim/2 mile run, 15 mile bike, 5k run Saturday - July 6, 2013 - 8:00 am	Individual By 6/30 6/30-7/5 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 4, 2013- 7:00 am	Individual By 7/28 7/28-8/3 Team USAT 1-day	$80 $95 $115 $12	$70 $85 $85 $12	____	____	____ ____
	Presidential Lakes Olympic Challenge Triathlon/Duathlon in the Pines Olympic - 1500 meter swim/5k run, 40k bike, 10k run Surday -Aug 11, 2013 - 7:30 am	Individual By 8/4 8/4-8/10 Team USAT 1-day	$90 $100 $125 $12	$80 $90 $95 $12	____	____	____
	Presidential Lakes Sprint Triathlon Sprint - 1/4 mile swim, 11 mile bike, 5k run Surday -Aug 11, 2013 - 8:00 am	Individual By 8/4 8/4-8/10 Team USAT 1-day	$70 $75 $95 $12		____	____	____
	3rd Annual Medford Lakes Coloney Triathlon 1/4 mile swim, 10 mile bike, 3 mile run Sunday -Aug 25, 2013 - 7:30 am	Individual By 8/18 8/18-8/24 Team USAT 1-day	$70 $75 $95 $12		_____	_____	____ ____
	DQ Triathlon at Marlton Lakes 1/4 mile swim, 11 mile bike, 3 mile run Saturday - Aug 31,, 2013 - 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 7, 2013 - 7:00 am	Individual Early Bird by 2/28 3/1-8/31 9/1- 9/6 Team USAT 1-day	$140 $160 $180 $155 $12	$115 $135 $155 $12	____	____	____ ____
	Long Beach Island Annual Tri/Du 1/4 mile swim or 1.5 mile run, 10 mile bike, 5k run Sunday - September 15, 2013 - 7:40 am	Individual By 9/8 9/8-9/14 Team USAT 1-day	$70 $85 $95 $12	$60 $75 $65 $12	____	____	____ ____
	Treasure Island Triathlon/Duathlon/AquaBike Kids Triathlon Kayak Tri 1/4 mile swim/1.5 mile run, 10.5 mile bike, 3 miles run Sunday, October 6, 2013 - 8:45 am	Individual By 9/29 9/29-10/5 Team 2 Team 3 USAT 1-day	$70 $75 $80 $95 $12	$60 $65 $90 $105 $12	____	____	____ ____
	EOS Triathlon/Duathlon/Aqua at Island Beach State Park 1/4 mile swim/2mile run, 10 mile bike, 5k run Saturday - October - 12, 2013 8:30 am	Individual By 10/6 10/7-10/10 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

Please Select Race(s)

___ Hammonton ___ Parvin ___ Stafford ___ 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

Club Affiliation: ______________________________________________________________

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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