Surname:         First name:  
Address:    
Address:  
Town:          Postcode:   Country:   

Contact telephone number:

Your eMail address

Age on race day:        Date of birth:         Male or Female

 TI membership number:        Club: 

ENTRY FEES
Seniors € 20 /Stg £15.00         Juniors € 10 /Stg £5.00                    Relay € 40 /Stg £30.00            1 Day Licence (TI) € 10.00/ Stg £10.00
Under TI regulations for insurance purposes a 1 day licence fee is charged to athletes who do not provide a valid 2003 TI membership card on race day (no exceptions) Entry Deadline: 25th July 2003
I enclose herewith my entry fee of € __________ Cheques to be made payable to Olympian Triathlon Club. Please return to:- Trudy Brown, 22 Lead Hill Park, Belfast, BT6 9RW Phone: 028 90 796037 email: trudy.brown@ucht.n-i.nhs.uk
Registration Opens 11:00 am Closes 12:00 noon sharp Race starts: 1:00 pm
HARD SHELL HELMETS MUST BE WORN DURING CYCLE
DECLARATION:
I declare that I am entering this Triathlon of my own choosing and no liability will be placed on the Organisers for any injury sustained or any property lost whilst participating in the event. I confirm that I have no medical disabilities which would endanger myself or others taking part.

Signature:______________________________ Date: ________________

Signature of Guardian if Junior:______________________________