register
*   I have read the Rules and Regulations and agree to abide by it.
*   First Name:
*  Last Name:
*  Address:
*  City:
*  Province/State:   2 Letters
*  Postal Code/Zip Code:
*  Country:
*  Home Phone number:     (xxx) xxx-xxxx
  Work Phone number:     (xxx) xxx-xxxx
  Cell Phone number:     (xxx) xxx-xxxx
*  Email address:
*  Confirm Email address:
*  Date of Birth:
*  Age on Race Day Saturday Aug 11, 2012:
*  Gender:
  • Male
  • Female
*  T-Shirt size?
  • X-Small
  • Small
  • Medium
  • Large
  • X-Large
  • XX-Large
Occupation:    
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Comments:    
How did you hear about the event?  
List any medical conditions:

------------------------------------   TEAM INFORMATION START   ------------------------------------

Enter Team INFO below:  Each Team Member MUST fill out a full Registration!!
If you are a single entrant (NO TEAM)
Just leave THIS ENTIRE SECTION BLANK

Team Name:

Combined team age:   

Team Category: Male
Female
Mixed

Swimmer:   Name:
Cyclist:   Name:
Runner:   Name:


--------------------------------------   TEAM INFORMATION ENDS   --------------------------------------
Certificate # (If Applicable)):

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