North Inner City Triathlon

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* 1. Are you entering as an Individual or Relay

Individual

Relay

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* 2. If you have selected a relay what is the name of your Team?

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* 3. What is the name of the team members on your team? (2 or 3 Max per team)

NAME 1

NAME 2

NAME3

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* 4. Contact Details

Name *

Address

Address 2

City/Town

Email Address *

Phone Number *

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* 5. Date of Birth

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* 6. Emergency Contact Name

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* 7. Emergency Contact Phone Number