Entry Form – Individual – Gloucester Tri Challenge

Payment is required to confirm your entry into the Tri Challenge event – Payment Details
The Medical Questionnaire and Waiver need to be completed and submitted to complete registration.

SURNAME(required)

FIRST NAMES(required)

ADDRESS(required)

POSTCODE(required)

CONTACT NUMBER(required)

EMAIL(required)

AGE ON RACE DAY(required)

DATE OF BIRTH(required)

EMERGENCY CONTACT NAME(required)

EMERGENCY CONTACT PHONE(required)

ELECTRONIC SIGNATURE: By clicking this box you are acknowledging that the information you provided is true and correct and by clicking this check box you are signing this form and agree to all the terms and conditions set out by the Gloucester Mountain Man Tri Challenge(required)

OPTIONAL: Please supply details & results of any other endurance events and triathalons you have entered

Gloucester Tri Challenge

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