Text Box: Race Fee Schedule   Received Before   Individual         Relay                June 20              55.00            110.00                 July 18              60.00             120.00         July 31              70.00             140.00  

 

 

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.

1701 Woodside Circle

Tupelo, MS 38801