Text Box: 2010 Race Fee Schedule   Received Before   Individual         Relay               March 1st             55.00            110.00               April 10th             60.00             120.00          April 26th             70.00             140.00          April 29th             80.00             160.00    

 

 

Individual or Swimmer of Relay

Participant_______________________ Age_____ D.O.B______________

Address:_________________________ 

City__________  State____  Zip_____
E-mail Address___________________________

Telephone (_____)____-_________ 

Gender     Male___    Female____  

T-Shirt Size   S     M     L     XL

Emergency Contact_______________ Phone(___)__________

Current USAT Member    Y      N

Valid USAT #__________ Exp._______

Relay 2 (Bike Participant)

Participant_______________________ Age_____ D.O.B______________

Address:_________________________ 

City__________  State____  Zip_____

E-mail Address___________________________

Telephone (_____)____-_________ 

Gender     Male___    Female____  

T-Shirt Size   S     M     L     XL

Current USAT Member    Y      N

Valid USAT #__________ Exp._______

Relay 3 (Run Participant)

Participant_______________________ Age_____ D.O.B______________

Address:_________________________ 

City__________  State____  Zip_____

E-mail Address___________________________

Telephone (_____)____-_________ 

Gender     Male___    Female____  

T-Shirt Size   S     M     L     XL

Current USAT Member    Y      N

Valid USAT #__________ Exp._______

Relay Team Name___________________

 

Please complete and detach this portion and return with check and correct fee to:

Tupelo MultiSport L.L.C.

PO Box 456   

Sherman, MS 38869