| Official Entry Form Chanoko Mt Bike Duathlon #1 Granite Beach, Folsom Lake, Granite Bay, CA |
| Last Name: | ______________________ | Street Address: | ___________________________________ | |||
| First Name: | ______________________ | City, State ZIP: | ___________________________________ | |||
| Gender: | Male Female | Phone: | ___________________________________ | |||
| Date of Birth: | ______________________ | Email: | ___________________________________ | |||
| Race Day Age: | ______________________ | Team/Club: | ___________________________________ |
| Category: | Relay Team Name: | |
| Individual Relay | ____________________________________ |
| Category: |
| 19 and under 20-29 30-39 40-49 50-59 60-69 70+ |
| Category: | Before Race Day: | On Race Day: | |
Chanoko Duathlon |
$40 | $50 | |
| Chanoko Duathlon Relay | $75 | $90 | |
| Chanoko MTB Duathlon Individual Series | $100 | ||
| Chanoko MTB Duathlon Relay Series | $200 | ||
| Total Body Fitness 5209 Blaze CT. Rocklin, Ca 95677 |
Make checks payable to: TOTAL BODY FITNESS Total Amount Enclosed: $_____________ |