Charity Triathlon for Kent Wildlife Trust Organised by Team Outrageous

* Swim 400m * Cycle 15km * Run 5km Date: Sunday 12th June 2011 Place: Leybourne Lakes (situated close to J4 M20, just of A228) Race Starts: 8.15 am Please be ready 15 minutes before race for briefing PLEASE COMPLETE PERSONAL DETAILS: Surname: Date of Birth:

Forename: /

/19

Sex:

M/F

Address:

Postcode: E-mail (please PRINT): Telephone No.:

Day/ Mobile:

Club /Team Name:

(if applicable)

Entry Fee: Please Tick

  

Evening:

£20 – I am a member of the British Triathlon Association £25 - I am not a member of the British Triathlon Association £30 - Entry on day

Minimum sponsorship £100 (that will go straight to work protecting wildlife in Kent) Free parking permit and goody bag for all entrants. Medals for all those who complete the competition. DISCLAIMER - Unsigned entry forms cannot be accepted & will be returned. I declare that I am of good health & fit to compete in a triathlon & do so at my own risk. I will abide by the rules of the organisers and agree to their terms & conditions. I will cycle with care & attention & abide by the normal rules of the road. I accept that the organisers & their friends & associates are not liable for any loss, damage, claim, injury (including fatal) or expense that may arise in consequence of my participation in any of the above events.

Signed: ………………………………………………………………… Date: ………/…………/ 2011 Please make cheque/postal order payable to ‘Team Outrageous’ and post, with entry form to: Team Outrageous 14 The Paddocks, Worlington, Suffolk IP28 8SB. For more information contact Mike Russell of Team Outrageous on [email protected]. Head Office: Kent Wildlife Trust, Tyland Barn, Sandling, Maidstone, Kent ME14 3BD Tel: 01622 662012 Fax: 01622 671390 www.kentwildlifetrust.org.uk [email protected] Registered Charity No. 239992. A company limited by guarantee No. 633098. VAT Registration No. 974 8423 78