PLEASE FILL OUT FORM COMPLETELY - MISSING INFORMATION MAY DELAY OFFICIAL ENTRY.
Please Note: USAT uses the "age-up" rule. Please use the age you will be on 12-31-2010.

2010 ENTRY FORM — US Women's Triathlon Series — Naperville Triathlon
Make check payable to:
CAPRI EVENTS
Send with signed entry postmarked by 5/24/10 to:
Capri Events
c/o SMA, 4562 N. 126th St., Butler, WI 53007
NO REFUNDS OF ENTRY FEES. US FUNDS ONLY
 NOTE: NO DIVISION CHANGES WILL BE ALLOWED AFTER 5/24/10.
NO EXCEPTIONS.
OFFICE USE ONLY
 
THIS FORM MAY
BE COPIED.

FIRST NAME

LAST NAME

STREET ADDRESS
CITY
STATE
ZIP

Age:
(as of 12-31-10)
Birth
Date:
Choose One: Shirt Size: YL  S  M  L  XL  XXL
Tank Top Size: S  M  L  XL
ChampionChip Timing:
I will Supply my own chip. CHIP CODE:
Work Phone: (___) _____________ Home Phone: (___) ______________
E-mail: ______________________________________________
Company: __________________________________________
Occupation: _________________________________________
In Case of Emergency Call:
Name: ______________________ Relationship: ____________
Phone: (___) _________________ Medical problem. Please
attach an explanation.
1/2 PRICE SUBSCRIPTION TO TRIATHLETE
YES! Send me one year of Triathlete Magazine for $29.95, which is 15% off the subscription price of $34.95. Take advantage of Triathlete's special offer created for competitors like you, who are the heart of the sport. Subscribe, or extend your current subscription to Triathlete and save!
OVARIAN CANCER RESEARCH FUND
Membership in USA Triathlon or a USAT single
event permit is required for participation
in the US Women's Triathlon.

Yes! I want to help even more!

I have included my tax deductible donation to the Ovarian Cancer Research Fund in the amount of:
$10   $20  $50  $100  Other _________

  I am/will be a USAT member on race day and will show
     my card at packet pickup. My 6 digit USA Triathlon
     membership number is: __ __ __ __ __ __.
  I am 18 years or older and need to purchase a $10.00
     USAT single event permit.
  I am 17 years or younger and need to purchase a $5.00
     USAT yearly permit.
  I will be on a Relay Team (fee is included in entry fee)
            For USAT information visit www.USATriathlon.org.
Please enter me in one of the following categories (please check ONE):
SPRINT
Division*
HAVE USAT License
17 & Under
ADD USAT Permit
18 & Over
ADD USAT Permit
 Age Group
box $  75
box $   80
box $   85
 Elite
box $   75
box $   80
box $   85
 Triumph
box $   75
box $   80
box $   85
 Family
box $   75
box $   80
box $   85
 Relay Team
box $ 140
*Included
*Included
Team Name:______________________________________
READ CAREFULLY BEFORE SIGNING: I acknowledge the following:(1) Prior to receiving my Event race packet, I will be required to show my photo ID and proof of my current USAT membership or my current USAT single event permit. (2) I will be required to sign and submit both the Event & USAT AWRL Forms and Event Swim Waiver, and if I am under 18-years in age, the signature of my parent or guardian is required. (3) Failure to meet any of the above criteria at the time of race packet pick up will disqualify me from participating in the Event. (4) There are no refunds of race entry fees, and Event entry transfers are the discretion of CAPRI Events.
Signature __________________________ Date ________ Parent's
Signature __________________________ Date ________
If participant is under 18 as of 6/13/10
CODE: web-IL