Gloucester Tri Challenge

Entry Form – Tandem

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

Tandem Teams comprise of two people riding the one bike, paddling in single kayak and both team members completing the run together.

PERSON 1

SURNAME

FIRST NAMES

ADDRESS

POSTCODE

CONTACT NUMBER

EMAIL

AGE ON RACE DAY

DATE OF BIRTH

GENDER

EMERGENCY CONTACT NAME

EMERGENCY CONTACT PHONE

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

PERSON 2.

SURNAME

FIRST NAMES

ADDRESS

POSTCODE

CONTACT NUMBER

EMAIL

AGE ON RACE DAY

DATE OF BIRTH

GENDER

EMERGENCY CONTACT NAME

EMERGENCY CONTACT PHONE

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

ENTRY FEE