American Red Cross, Posey County

2004 TRIAthlon

disaster relief Benefit

for the

american red cross, posey county

Distances: 500 m Swim, 18.5 mile Bike, 5 k Run

Date: September 11, 2004

Location: Harmonie State Park

Entry Fee: $20.00 for individual participant

$45.00 for a team of three

Registration Deadline: 4:00 p.m., Friday, August 15, 2004

($5.00 per person late fee for registration 8/15/04 – 9/7/04)

NO ONSITE REGISTRATION

Participation is open to individuals or teams of three. Prizes will be awarded accordingly.

Vision: To encourage participation in sports, encourage good sportsmanship and to raise funds for disaster and other emergency services provided by the Posey County Red Cross Chapter. Proceeds to benefit Posey County Disaster Relief.

Participants will receive a t-shirt. Participants must pay the Harmonie State Park gate fee. Participants must wear bicycle helmets when competing in the bicycle portion of the triathlon. Participants or guardian must also sign the release on the entry form.

Junior Triathlon (Under 14 years old) also available. Contact Red Cross office for more information.

* This sheet may be photocopied for additional participants.

(Please Print)

Individual Participation Registration ($20.00 enclosed)

Name:______Birth Date:___/___/___

Address: ______Adult T Shirt Size ______

City: ______State: ___ Zip: ______Phone #: ______

Seed time for 500 m swim______

Team Participation Registration ($45.00 enclosed)

Name: ______(Swim) Birth Date: ___/___/___

Address: ______Adult T Shirt Size ______

City: ______State: ___ Zip: ______Phone #: ______

Name: ______(Bike) Birth Date: ___/___/___

Address: ______AdultT Shirt Size ______

City: ______State: ___ Zip: ______Phone #: ______

Name: ______(Run) Birth Date: ___/___/___

Address: ______Adult T Shirt Size ______

City: ______State: ___ Zip: ______Phone #: ______

Seed time for 500 m swim______

RELEASE: (Must be signed by each name listed above in order to participate) In consideration for accepting my entry and allowing me to participate in the 2004 Triathlon Disaster Relief Benefit for the American Red Cross, Posey County Chapter to be held in Harmonie State Park on September 11, 2004, I, for myself, my executors, and assigns, do hereby release the American Red Cross, Posey County Chapter, the Indiana Department of Natural Resources, the event sponsors and their directors, officers, employees and volunteers from all claims for injury or damage and from all actions of any nature arising out of my participation in the event. I understand the physical demands and risks of the event and certify that I, and my equipment, are prepared for the event. If the participant is under 18 years of age, that participant’s parent or legal guardian must execute this release on behalf of the participant.

Date: ______Signed:______

Mail Entry Form & Checks to: American Red Cross

Posey County Chapter

e-mail: 1001 A North Main Street

Mt. Vernon, IN 47620

(812) 838-3671

2004 JUNIOR TRIAthlon

disaster relief Benefit

for the

american red cross, posey county

(AGE 14 YEARS AND YOUNGER)

Distances: 300 m Swim,6.5 mile Bike, 3.5 k Run

(Distances are approximate. More info with registration confirmation.)

Date: September 11, 2004

Location: Harmonie State Park

Entry Fee: $10.00 for individual participant

$30.00 for a team of three

Registration Deadline: 4:00 p.m., Friday, August 15, 2004

($5.00 per person late fee for registration 8/15/04 – 9/7/04)

NO ONSITE REGISTRATION

Participation is open to individuals or teams of three. Prizes will be awarded accordingly.

Triathlon also available. Contact Red Cross office for more information.

* This sheet may be photocopied for additional participants.

(Please Print)

Individual Participation Registration ($10.00 nclosed)

Name:______Birth Date:___/___/___

Address: ______Adult T Shirt Size ______

City: ______State: ___ Zip: ______Phone #: ______

Seed time for 300 m swim______

Team Participation Registration ($30.00 enclosed)

Name: ______(Swim) Birth Date: ___/___/___

Address: ______Adult T Shirt Size ______

City: ______State: ___ Zip: ______Phone #: ______

Name: ______(Bike) Birth Date: ___/___/___

Address: ______AdultT Shirt Size ______

City: ______State: ___ Zip: ______Phone #: ______

Name: ______(Run) Birth Date: ___/___/___

Address: ______Adult T Shirt Size ______

City: ______State: ___ Zip: ______Phone #: ______

Seed time for 300m swim______

Date: ______Signed:______

Mail Entry Form & Checks to: American Red Cross

Posey County Chapter

e-mail: 1001 A North Main Street Mt. Vernon, IN 47620

(812) 838-3671