Select one event:
Sprint Triathlon
Olympic Triathlon
Relay Team Triathlon
Last Name:
First Name:
Address :
City :
Province or State:
Please use 2 letter abbreviation
Postal code or Zip code:
Country:
home phone number:
work phone number:
Email address:
Age on Dec. 31, 2010:
Date of Birth:
Gender:
Male
Female
T-shirt sizePlease note, shirt sizing and availabilitly may be limited or not available at all if registering after May 1, 2010.
Small
Medium
Large
X-Large
XX-Large
TriBC # (or equivalent):
(An additional $15.00 will be charged on
your entry form if no VALID TriBC# is provided )
Other triathlon accomplishments?:
If you are a member of a Triathlon Club please indicate which one:
Not a Club member
Chilliwack Triathlon Club
Coquitlam Triathlon Club
Fast Lane Triathlon Club
Focus Racing Team
Fraser Valley Triathlon Club
Kal RATS Triathlon Club
Kamloops Triathlon Club
Kelowna Triathlon Club
LaFong Triathlon Club
Los Rapidos Triathlon Club
Nanaimo Triathlon Club
North Shore Triathlon Club
Pacific Spirit Triathlon Club
Peninsula Plodders Running Club
Peninsula Triathlon Club
Penticton Triathlon Club
Poseidon Triathlon Club
Prince George Triathlon Club
Revolution Multi-Sport Club
Salmon Arm Triathlon Assoc.
SFU Multi Sport Club
Steveston Triathlon Club
Strathcona Triathlon Club
Team Orca
Team Westcoast
Trilight Zone
UBC Triathlon Club
UVic Triathlon Club
Vancouver Falcons
If your club is not listed above please enter the name of your club here:
If participating on a team please enter the team information below:
Team Name:
Swimmer:
Cyclist:
Runner:
* MEDICAL QUESTIONNAIRE
The following information is necessary to the Wine Capital of Canada Triathlon medical staff to ensure
proper care in the event of accident or illness during the race.
1. Do you have any current or recurrent medical conditons for which you are being treated by a doctor?
2. Are you on any medications?
3. Are you allergic to any medications or to insect stings?
If you ( or any of your team members ) answer YES to any of the above questions please
describe here:
If you wish our medical staff to be aware of any specific medical conditions, please contact:
joe@outbackevents.ca with further details.
How many Wine Capital of Canada Sprint Triathlons have you completed:
0
1
2
3
4
5
6
7
WAIVER,RELEASE AND INDEMNIFICATION - In my entry for this race, I, the undersigned, intending to be legally bound, hereby for myself, my heirs and administrators, waive and release I WAIVE, RELEASE, AND DISCHARGE from any and all claims or liabilities for death, personal injury, property damage, theft or damages of any kind, which arise out of or relate to my participation in, or my traveling to and from the Wine Capital of Canada Triathlon Event, THE FOLLOWING PERSONS OR ENTITIES: Wine Capital of Canada Triathlon, Outback Events Ltd, Triathlon BC, Town of Oliver, Oliver Parks & Recreation Society, Ministry of Transportation and Highways, Ministry of Water Lands & Parks, School District 53, event sponsors, event directors, event producers, volunteers, all venues in which events or segments of events are held, and the officers, directors, employees, representatives and agents of any of the above; I AGREE NOT TO SUE any of the persons or entities mentioned above for any of the claims or liabilities that I have waived, released or discharged herein; and I hereby agree that in the event of cancellation due to a storm, rain, winds, inclement weather, or other "Acts of God" conditions, my registration fee shall not be refunded. I hereby grant permission to any and all of the foregoing to use any photographs, motion pictures, videotapes, recordings or any other record of the event for any purpose including commercial use. I understand that my email address and contact information will be shared with the Official Event photographer.
Check this tick box to agree to the waiver, and to the no-refund policy:
Check this tick box to agree to the no-refund policy: