DECAIRONMAN2009 - page 9 of 19

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ENTRY FORM BY TEAM

DECA IRONMAN WORLD CHALLENGE 2009

Name ______________________________________________________________

Swimming Time in 100 mts.____________ Swimming Time in 3.8 km.___________

Address_____________________________________ City____________________

State__________________ Country________________ Zip Code ______________

Tel home____________________ Fax home_______________________________

Tel office____________________ Fax office________________________________

E-Mail ________________________________Birth date______________________

Category _______________ Sex______________ Age (on Nov 5th 2007)_________

T Shirt size (please circle): S M L XL

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Best Ultra triathlon races:

_______________________________________________________________________

Waiver: I realize there are risks associated with competing in this event and in consideration of our

accepting in this entry, I, the below signed, intending to be legally bound for myself, my heirs, executors

and administrators, waive and against any persons, organizations, officials, and / or sponsors of the

event that I will participate, named above, and their representative, successors, and assigns for any and

all injuries suffers by me in this event. I attest and verify that I am physically fit and have sufficiently

trained for the competition of this event. Further, I grant full permission to any and all of the foregoing to

use photographs, videotapes, motion pictures and recordings of me, or other record of this event.

For legitimate purpose. Also, I understand that the race Director has the right to reject any entry

form and pull out any athlete from the race.

Signature_________________________ Date_________________________

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