* Select one event:
Sprint Triathlon
Olympic Triathlon
Relay Team Olympic Triathlon
* Last Name:
* First Name:
* Address :
* City :
* Province or State:
Please use 2 letter abbreviation
* Postal code or Zip code:
* Country:
* home phone number:
work phone number:
* Email address:
* Age on Dec. 31, 2013:
* Date of Birth:
* Gender:
Male
Female
* T-shirt sizePlease note, shirt sizing and availabilitly may be limited sizing after
Sept 9th.
----Choose T-Shirt Size-----
Men's Small
Men's Medium
Men's Large
Men's X-Large
Men's XX-Large
Men's XXX-Large
Women's Small
Women's Medium
Women's Large
Women's X-Large
Women's XX-Large
Women's XXX-Large
TriBC # (or equivalent):
(An additional $15.00 will be charged on
your entry form if no VALID TriBC# is provided )IF YOU DO NOT HAVE A TRIBC/ATA # BUT ARE PLANNING ON GETTING ONE PRIOR TO THE EVENT, PLEASE TYPE IN 1234 OR YOU WILL BE CHARGED THE $15 ALONG WITH YOUR REGISTRATION
How many Triathlon's have you completed in?:
Other triathlon accomplishments?:
If you are a member of a Triathlon Club please indicate which one:
Not a Club member
Chilliwack Triathlon Club
Coquitlam Triathlon Club
Fast Lane Triathlon Club
Focus Racing Team
Fraser Valley Triathlon Club
Kal RATS Triathlon Club
Kamloops Triathlon Club
Kelowna Triathlon Club
LaFong Triathlon Club
Los Rapidos Triathlon Club
Nanaimo Triathlon Club
North Shore Triathlon Club
Pacific Spirit Triathlon Club
Peninsula Plodders Running Club
Peninsula Triathlon Club
Penticton Triathlon Club
Poseidon Triathlon Club
Prince George Triathlon Club
Revolution Multi-Sport Club
Salmon Arm Triathlon Assoc.
SFU Multi Sport Club
Steveston Triathlon Club
Strathcona Triathlon Club
Team Orca
Team Westcoast
Trilight Zone
UBC Triathlon Club
UVic Triathlon Club
Vancouver Falcons
If your club is not listed above please enter the name of your club here:
If participating on a team please enter the team information below:
Team Name:
Swimmer:
Cyclist:
Runner:
* MEDICAL QUESTIONNAIRE
The following information is necessary to the Cultus Lake Triathlon medical staff to ensure
proper care in the event of accident or illness during the race.
1. Do you have any current or recurrent medical conditons for which you are being treated by a doctor?
2. Are you on any medications?
3. Are you allergic to any medications or to insect stings?
If you ( or any of your team members ) answer YES to any of the above questions please
describe here:
If you wish our medical staff to be aware of any specific medical conditions, please contact:
joe@outbackevents.ca with further details.
Emergency contact name:
Emergency contact phone:
In my entry for this race, I, the undersigned, intending to be legally bound, hereby for myself,
my heirs and administrators, waive and release Outback Events Ltd and their volunteers and
representatives, Triathlon British Columbia and its divisions and the Cities of Chilliwack
and Abbotsford, Fraser Valley regional District, Cultus Lake Parks Board and the Ministry
of Transportation of Highways for any and all injury or loss by me howsoever caused,
whether through negligence or willful conduct of the officers, directors, employees,
agents or appointees of the association(s) and its divisions whether such loss or
injury occur while traveling to or from the event or while staying at or participating
in the program or activity of the event. I hereby agree that in the event of
cancellation due to a storm, rain, winds, inclement weather, or other "Acts of God"
conditions, my registration fee shall not be refunded. I hereby grant permission to
any and all of the foregoing to use any photographs, motion pictures, videotapes,
recordings or any other record of the event for any purpose including commercial use.
I understand that my email address and contact information will be shared with the
Official Event photographer.
I have read this waiver and fully understand its contents. Outback Events Ltd has
provided the opportunity to explain this to me.
In my entry for this race, I, the undersigned, intending to be legally bound, hereby for myself,
my heirs and administrators, waive and release Outback Events Ltd and their volunteers and
representatives, Triathlon British Columbia and its divisions and the Cities of Chilliwack
and Abbotsford, Fraser Valley Regional District, Cultus Lake Parks Board and the Ministry
of Transportation of Highways for any and all injury or loss by me howsoever caused,
whether through negligence or willful conduct of the officers, volunteers, directors,
employees, agents or appointees of the association(s) and its divisions whether such
loss or injury occur while traveling to or from the event or while staying at or
participating in the program or activity of the event. I have read this waiver
and fully understand its contents. Outback Events Ltd has provided the opportunity
to explain this to me.
Check this tick box to agree to the waiver policy:
Check this tick box to agree to the no-refund policy: