Name or Team Captain ___________________________________________

Mailing Address __________________________________________________

City, State, Zip ___________________________________________________

Phone _______________ E-mail Address _____________________________

Age on race day___ Date of Birth___________USAT #__________Sex - M F

       Triathlon fees                                                           Duathlon fees
$55 USAT member & Military untill 5/29/10              $55 USAT member untill 5/29/10
$65 Non USAT member untill 5/29/10                     $65 Non USAT member untill 5/29/10
$75 everyone 5/30/10 thru race day                       $75 everyone 5/30/10 thru race day
$120 Team relay fee                                            $105 Team relay fee

Team must provide a team name and all members must sign waiver.

In consideration of the acceptance of my entry, I, for myself, my executors, administrators and assignees do hereby release and discharge MultiSport Maniacs, and all associated sponsors of all claims and damages, demands, actions whatsoever in any manner arising out of my participation in said athletic event. I attest and verify that I have full knowledge of the risks involved in this event and I am physically fit and sufficiently trained to participate in this event. I have fully read and understood the race application, rules and information whether on the web site or on the application and will abide by all the rules therein.

Each Relay Members Must Sign Below:

Team Name _______________________________________________

Swim ______________________________________________________

Bike _______________________________________________________

Run _______________________________________________________

Individual Signature _________________________________________
(Parent's if under18)

For more information call Chad - 717-991-9102 or e-mail: chad.krebs@multisportmaniacs.org 
                   
A portion of the proceeds will benefit the YMCA and Families of Deployed Soldiers