TRIEXERCISE PEMBROKESHIRE COAST TRIATHLON

TRIEXERCISE PEMBROKESHIRECOAST TRIATHLONWELSH STANDARD DISTANCE CHAMPIONSHIPSWELSH TRIATHLON GRAND PRIX EVENTSaturday 7 th July 2012, Broad Haven1.5k swim / 43k bike / 10.6k runWelsh Championship EligibilityENTRY FORM - INDIVIDUALThe event will incorporate the Welsh Standard Distance Triathlon Championships (for seniors andabove). To qualify for the Championships, you MUST be a paid up member of Welsh Triathlon onrace day (see www.welshtriathlon.org for more details). In addition, you must also satisfy one ofthe following criteria:Born in Wales, orOne Welsh Parent, orResident in Wales continuously for at least 3 years.The Welsh Championships applies to seniors and above only, with categories for Senior (age 20-39), Veteran (40-49), Super Veteran (50-59) and Vintage Veteran (60+).Additional InformationPlease complete and return the entry form overleafThe race limit is 250 so enter early to avoid disappointmentA Race Pack is available on our web-site at www.pembrokeshire-tri.org.uk/pct.htmWe will be organising 3 taster sessions, one each for swim, bike & run, which will use the eventcourse – please see web-site for further detailsIf you have any queries or need further information, please e-mailpembrokeshirecoasttriathlon@sporty.co.uk or telephone David Astins on 07766 911069

ENTRY FORM - INDIVIDUALPlease complete ALL boxesNameAddressE-mail (please print clearly)Tel. No(s).Emergency contact: Name NumberMale / Female (M or F)Club / Team / CompanyBritish Triathlon Member? Y / N Membership no (inc. letter prefix)Eligible for Welsh Championships? (see previous page)Y / NDate of birth (min. age 17 as at 31/12/12) Age on 31/12/12Age Category(please circle – as at 31/12/12)Junior(17-19)Open(20-39)Veteran(40-49)Super Vet.(50-59)Vintage Vet.(60+)T-shirt size required (please tick):XXS (32”) XS (34”) S (35”-37”) M (38”-40”) L (41”-43”) XL (44”-46”)Entry fee enclosed: £49 (please tick)Cheques: PEMBROKESHIRE TRIATHLON EVENTSBritish/Welsh Triathlon members must produce their race licence at registration. Everyone else mustpurchase a day licence (£5 for individuals, £3 for each member of a relay team) – please bring the correctchange with you to registration. No licence = no race. No exceptions. For details of the benefits of joiningWelsh Triathlon please visit www.welshtriathlon.org.Return this form, with your cheque & an A5 S.A.E. for the race information pack (NOT NEEDED IF YOUHAVE PROVIDED AN E-MAIL ADDRESS), to: Pembrokeshire Coast Triathlon, c/o 32 Tudor Way,Haverfordwest, Pembrokeshire, SA61 1HU. We will not accept entries that arrive after the closing date ofSATURDAY 30 th JUNE. After this date we will operate a reserve list: ‘phone 07766 911069 for details.Photographs from the event may be used in the press and future promotions. Please notify the race directorif you do not wish to appear (e-mail: pembrokeshirecoasttriathlon@sporty.co.uk).Disclaimer:I declare that I will abide by the rules of British Triathlon and accept that British Triathlon and its agents, andthe event organisers and their associates, are not liable for any loss, damage, claim or expense which mayarise as a consequence of my participation in this event. I will cycle with care and attention and abide by thenormal rules of the road. I am of good health and compete at my own risk.Signed:Date:Remember to enclose your completed entry form, cheque & an A5 size S.A.E. (ONLY if you are NOT one-mail). CASHING OF YOUR CHEQUE IS PROOF OF ENTRY. You will be e-mailed/sent a race packshortly after the closing date. Enclose a second A5 S.A.E. marked “results” if you would like results posted.