Men's Try-a-Tri Initiative 2017
Application Form

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* 1. Background Information:

Name:

Address:

Tel number:

Email:

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* 2. Date of Birth

Date / Time

Date

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* 3. Please tick the number of times you participate in the following:

	None	1 a month	1 a week	2 a week	3 a week	more
Swimming	Swimming None	Swimming 1 a month	Swimming 1 a week	Swimming 2 a week	Swimming 3 a week	Swimming more
Cycling	Cycling None	Cycling 1 a month	Cycling 1 a week	Cycling 2 a week	Cycling 3 a week	Cycling more
Running	Running None	Running 1 a month	Running 1 a week	Running 2 a week	Running 3 a week	Running more
Other	Other None	Other 1 a month	Other 1 a week	Other 2 a week	Other 3 a week	Other more

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* 4. On a scale of 1 to 5 please rate the following:

	1 (Low)	2	3	4	5 (High)
My swimming skills	My swimming skills 1 (Low)	My swimming skills 2	My swimming skills 3	My swimming skills 4	My swimming skills 5 (High)
My cycling skills	My cycling skills 1 (Low)	My cycling skills 2	My cycling skills 3	My cycling skills 4	My cycling skills 5 (High)
My running skills	My running skills 1 (Low)	My running skills 2	My running skills 3	My running skills 4	My running skills 5 (High)
My physical fitness level	My physical fitness level 1 (Low)	My physical fitness level 2	My physical fitness level 3	My physical fitness level 4	My physical fitness level 5 (High)
My confidence to participate in sport	My confidence to participate in sport 1 (Low)	My confidence to participate in sport 2	My confidence to participate in sport 3	My confidence to participate in sport 4	My confidence to participate in sport 5 (High)

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* 5. Please rate the importance of the following elements which influenced you to apply for this programme:

	1 (Not Important)	2	3	4	5 (Very Important)
Location	Location 1 (Not Important)	Location 2	Location 3	Location 4	Location 5 (Very Important)
Time	Time 1 (Not Important)	Time 2	Time 3	Time 4	Time 5 (Very Important)
Cost	Cost 1 (Not Important)	Cost 2	Cost 3	Cost 4	Cost 5 (Very Important)
Peer/Club Support	Peer/Club Support 1 (Not Important)	Peer/Club Support 2	Peer/Club Support 3	Peer/Club Support 4	Peer/Club Support 5 (Very Important)
Something new	Something new 1 (Not Important)	Something new 2	Something new 3	Something new 4	Something new 5 (Very Important)
Men only	Men only 1 (Not Important)	Men only 2	Men only 3	Men only 4	Men only 5 (Very Important)
Weight loss	Weight loss 1 (Not Important)	Weight loss 2	Weight loss 3	Weight loss 4	Weight loss 5 (Very Important)
Healthy lifestyle	Healthy lifestyle 1 (Not Important)	Healthy lifestyle 2	Healthy lifestyle 3	Healthy lifestyle 4	Healthy lifestyle 5 (Very Important)
Social aspect	Social aspect 1 (Not Important)	Social aspect 2	Social aspect 3	Social aspect 4	Social aspect 5 (Very Important)

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* 6. Participation in all three disciplines will require the following equipment:
Swimming togs, Googles, Swimming Hat, Bike, Bike Helmet, Runners, Tube Repair Kit
If you don't have and are unable to borrow any of the equipment, please list what you would need and the club will endeavor to provide you with your outstanding pieces of equipment/clothing

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* 7. Do you have any relevant health conditions which may prevent you from training?

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* 8. As a participant of this programme, I agree to attend 2 coached sessions per week for 6-8 weeks

Yes

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* 9. I understand this programme is for men who have not previously taken part in a Try-a-Tri programme or triathlon event

Yes

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* 10. I understand there is a fee of €50 to confirm my place through the PayPal link

Yes