12th Annual Rec Your  Body Indoor Triathlon

February 28, 2009; 9AM Start

SIUC Student Recreation Center


                                Carbondale, IL 


Last Name  _____________________________  

First Name ___________________

Address: __________________________________   City __________ 

State _____  Zip ______

Day Phone (___) ___________  Date of Birth ______________ 

Age on Race Day ______     Sex  M ____  F ____

Please Check One According to Swimming level:
Beginner  ____         Intermediate ____    Advanced triathlete _____

Entry Fee        ________ $  10.00

Optional Event T-shirt   _______ $10.00

              Indicate size   S___  M ____   L ____ XL ____

Total enclosed   $_______             Make checks payable to SIUC. 

Mail your entry to:

          Triathlon Club, Cay Gerlock
          1104 Marion St.
          Carterville, IL 62918

PLEASE READ THE FOLLOWING INFORMATION CAREFULLY.  SIGN IT ONLY IF YOU
AGREE TO THE TERMS.  FAILURE TO SIGN RESULTS IN LOSS OF PARTICIPATION RIGHTS.

By signing this waiver and release, I am aware that sporting and athletic activities
as undertaken by the Southern Illinois University at Carbondale Triathlon Club involve physical exertion, specialized skills including: swimming, biking & running. 
I understand that participation in these activity carries with it inherent risks.  I
understand that these risks include but are not limited to accidents resulting in
debilitating injury, loss of personal property and death.  I understand that I am
responsible for my actions during these club activities.  I understand that I agree
to abide by all rules of safety and conduct as set forth by Southern Illinois University at Carbondale Triathlon Club.  I understand that the Board of Trustees of Southern Illinois University, its employees and agents, and Triathlon Club
officers and all other race sponsors are not responsible for loss of property, injury
or death that occurs during the course of this Triathlon Club event.  I grant permission to all of the aforementioned to use any photographs, motion pictures,
recordings, or any other record of this event for any legitimate purpose. I affirm that I am voluntarily signing this agreement, without any promises having
been made to me for doing so. I have read this form and agree to the terms
and conditions herein.


_________________________  ______________________  ___________
Participant's Signature                     Parent's/Guardian Signature           Date
                             (For participants under 18 years of age
                             Parent/Guardian must be present during
                             the event)