this form can be used for any  TNT events

TNT sports MARKETING

 Race name ______________________

 Last Name___________     First Name __________________ 
 
Sex __________       Age___________   

 USAT #____________      

 Date of Birth --- (MM/DD/YY)  ________-____-____  

Amount Enclosed    $_____________ 

Address ________________________________ City_____________State_______

Zip Code__________   
   

 telephone / with Area code_______-_______-__________

Email address____________________________

Shirt size M___L___XL__XXL__

 

DIRTY TRI $65 , GATOR HALF $225, XTERRA $65   

Team Name_____________________________________

 *** IMPORTANT CIRCLE ONE

 Elite   Age Group.    Clydesdale.   Athena.   Relay         

circle one         TRIATHLON     DUATHLON   MTB category  _________________________

 In consideration of this entry, I, for myself, my heirs, devises, executors, administrators and assigns hereby waive, release and discharge any and all Claims against Maverick & associates inc., TNT event marketing, Bikesenjava, Sarasota County Parks Dept., Sarasota County Sheriffs Dept., organization sponsoring or conducting this event, or their employees, representatives, or successors, for any and all damages or Injuries I may suffer. I hereby grant permission for the free use of my name and picture in any broadcast, brochure or account of this event. 

 ____________________________________________ ________________

 SIGNATURE / NO ENTRIES UNDER 18 / All TEAM MEMBER SIGN DATE

 MAKE CHECKS PAYABLE TO AND MAIL TO:  TNT event marketing 3522 branch Creek Drive Sarasota Florida 34235

  No refunds.

 RACE DIRECTOR: THIERRY EMAIL: ROUILLARD64@MSN.COM