| Official Entry Form Golden State Triathlon & Super-Sprint Triathlon Discovery Park, Sacramento, CA |
| Last Name: | ______________________ | Street Address: | ___________________________________ | |||
| First Name: | ______________________ | City, State ZIP: | ___________________________________ | |||
| Gender: | Male Female | Phone: | ___________________________________ | |||
| Date of Birth: | ______________________ | Email: | ___________________________________ | |||
| Race Day Age: | ______________________ | Team/Club: | ___________________________________ |
| Category: | Division: | Relay Team Name: | ||
| Individual | Age-Group Athena/Clydesdale | |||
| Relay | Male Female Co-Ed | ____________________________________ |
| Category: | Until 9/2/12 |
Until race day |
On Race Day: |
|
| Golden State Triathlon |
$75 |
$85 |
$95 |
|
| Super Sprint Triathlon |
$55 |
$65 |
$70 |
|
| Relay |
$130 |
$130 |
$150 |
|
| Total Body Fitness 5209 Blaze CT. Rocklin, Ca 95677 |
Make checks payable to: TOTAL BODY FITNESS Total Amount Enclosed: $_____________ |