Sumer/Fall Program Registration 2013

Ironman Boulder 2014 Program Registration Form

* Indicates required field

Name *

First

Last

Email *

Age *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Choose Your Run Pace Group *

Ironman Goal Race *

Other race and date *

Experience Level *

Beginner/Novice (<1yr) Intermediate (1 - 3 yrs) Advanced (3 yrs +)

Will this be your first Ironman? *

Yes No

Briefly describe your Triathlon experience i.e. how many, distance etc *

Recent 10K best mm:ss (within last 2 yrs) *

Recent 1/2 Mara best hh:mm:ss (within last 2 yrs) *

Recent Marathon best hh:mm:ss (within last 2 yrs) *

How did you hear about this program? *

If you were referred by friend or family, please give us their name *

Waiver and Release of Liability Statement.
I am aware that joining the Revolution Running Program will include running, cycling and swimming and that these activities involve risks. I understand that traffic will be on group run course routes. I assume the risk of running or walking in traffic. I also assume any and all other risks associated with participating in the program including, but not limited to falls, contact with other participants and trail users, the effects of weather, including heat and/or humidity, cold, wind, snow, rain, or ice and the conditions of the roads, all such risks being known and appreciated by me. I should not participate in the Revolution Running program unless I am medically able and physicaly capable. I understand that I am solely responsible for my own safety while traveling to and from or participating in this program. I hereby for myself, my heirs, executors, administrators or anyone else who might claim on my behalf covenant not sue, and waive, release, and discharge Revolution Running, BoulderRunning Company, Ewen North and Heather North or any sponsor or contributor to this program, any official or volunteer, any city or municipality, their representatives, successors or assigns, from any and all claims of liability for death, personal injury or property damage of any kind or nature whatsoever arising out of or in the course of my participation in this program. The Release and Waiver extends to all claims of every kind or nature whatsoever, foreseen, known or unknown.

By checking here you agree to the above waiver *

I agree to the above waiver.

Date of Birth *

Electronic Signature *

Refunds Policy *

I understand there are no refunds

Ironman Boulder Registration

Ironman Boulder 2014 Program Registration Form

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