Type in your information in the blanks provided. Be sure you've spelled everything correctly. What you type is what we will use for your registration. When you are done, click the print button to the rightuse your browser's print function.
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Each participant MUST fill out a separate entry form in it's entirety and sign the waiver. All team entries must be mailed together in one envelope.
Which event would you like to participate in?
Individuals $110- PPU & DOR
Relay Teams (per person) $65 - PPU & DOR
Make checks payable to:
Rotary Triathlon of Salem
Mail entry to:
For On-Site Registration Only
WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY
WAIVER MUST BE READ, SIGNED AND MAILED WITH ENTRY I understand that participating in an organized athletic event is potentially hazardous, and that I should not enter to participate unless I am medically able and properly trained. I HEREBY ASSUME ALL RISKS OF PARTICIPATING IN THIS EVENT including but not limited to falls, contact with other participants, spectators or vehicles, the effects of weather and conditions of the course, lack of physical readiness, all risks being known and appreciated by me. I certify that I am physically fit and that I have sufficiently trained. This release shall be binding and I hereby take the following action for myself, my executors, administrators, heirs, next of kin, successors and assigns, or anyone else who might claim or sue on my behalf. I agree that Rotary Club and any and all owners, employees, directors, volunteers, persons, sponsors, beneficiaries, participants, and all government agencies not be liable or responsible for any injuries to me resulting from my participation in this event even though that liability, may arise out of negligence or carelessness on the part of the personal and entities named in this waiver. I agree not to sue and I hereby waive, release and will indemnify and hold harmless the Rotary Club of Salem, and any and all owners, employees, directors, volunteers, persons, sponsors, beneficiaries, participants, and all government agencies from all claims, losses, liabilities, actions, judgments and the like of any kind including but not limited to death, personal injury, partial or permanent disability, property damage, medical or hospital bills or theft which may arise out of or relate to my participation in this event. I grant permission to all of the foregoing to use my name, likeness and identity in any photograph, motion picture, recording or any other record of this event for any legitimate promotional purpose. I understand that the Rotary Club. will use my email address for promotional purposes. I understand that the Entry Fees are Non-Refundable. I agree that I will not let anyone else race on my behalf. I agree that if I transfer my race to another individual, I will inform the race director to maintain credibility of the results and to assure the race director has all required emergency contact information. I understand that if I transfer my racing chip or bib to another individual without informing the race director, that individual will be disqualified and I will be fined. I have read this release and I understand all of its terms. I sign it voluntarily and with full knowledge of its significance. By agreeing to this Waiver I certify that I am 18 years of age or older or am the parent or legal guardian of the applicant and make these representations on behalf of my child or ward.
(Signature of Participant or Parent / Legal Guadian if participant is under the age of 18)