Sunday 21st June 2009
Please fill in all sections applicable (captains name only for relay race team). Print & post this form
First Name
Last Name
Address
Town
Tel Day
County
Tel Eve
Post code
Nationality
Email  
D.O.B
Sex
 Male Female
   
Age on 31 Dec 2009
Will 2009 be your first year competing at triathlon ?
Yes No
 
Will you be a BTF member on race day ?
Yes No
 
Team name (if any)
T-shirt size S M L XL  
Relay second team member S M L XL Relay third team member S M L XL
How did you get to know about this triathlon event ?
Competed previously
220 Magazine
Poster
BTF mail out
Told by a friend
Internet
   
Other (Please specify
Please tick if you do not wish to receive information for our future events
ESTIMATED TIME swim 200m mins secs Fun
ESTIMATED TIME swim 500m mins secs Sprint
RACE SELECTION (Tick the box of the race/s you wish to enter)
Henley-on-Thames Fun Triathlon (200m Swim - 20k Bike - 2.5k Run)   £35.00 BTF Member  
Henley-on-Thames Fun Triathlon (200m Swim - 20k Bike - 2.5k Run)   £40.00 Non BTF Member 
Henley-on-Thames Sprint Triathlon (500m Swim - 20k Bike - 5k Run) )   £37.00 BTF Member 
Henley-on-Thames Sprint Triathlon (500m Swim - 20k Bike - 5k Run)   £42.00 Non BTF Member  
Henley-on-Thames Relay Triathlon (500m Swim - 20k Bike - 5k Run) (One competitor for each leg!)  £50.00   
BTF Members will be asked to produce their race licence at registration
For entries received after the closing date of 8th June 2009 add £10.00 late entry fee or entry will be returned
(subject to availability, this does not guarantee your entry!). Sorry no entries on race day. No need to send S.A.E.’S.
PAYMENT TOTAL ENCLOSED Credit Card, Switch or cheque £
Card Number
- - -
Valid from date  
/
If applicable

Please consult your credit/debit card statement or
bank statement for confirmation of entry.
Final details will be sent to you via email or post.
Expiry date
/
 
Issue No (switch only)
 
 
OR please make cheque/postal order payable to
“Excellent Promotions” & post to Unit 20, Cockshades Farm, Wybunbury, Cheshire, CW5 7HA
 
I want to compete for Cancer Research UK
 
DISCLAIMER Min age 14 (fun/Sprint) on the 31 Dec 2009. Parents signature required for under 16.
Unsigned entry forms cannot be accepted & will be returned. I declare that I am of good health & fit to compete in a triathlon & do so at my own risk. I will abide by the rules of the organisers and agree to their terms & conditions. I will cycle with care & attention & abide by the normal rules of the road. I accept that the organisers & their friends & associates are not liable for any loss, damage, claim, injury (including fatal) or expense that may arise in consequence of my participation in any of the above events.
       
Sign Print Date