DIPOLOG TRIATHLON 105 Firstname * Lastname * Email * Mobile No. * City/Municipality/Province * Team Age * AGE ON DEC. 31, 2018 Birthdate * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012 Emergency Contact Person * Telephone No. of Emergency Contact Person * T-shirt Size * - Select -#14#16#18#20XSmallSmallMediumLargeXLarge2XLarge3XLarge4XLarge SIZE CHART: MALE • FEMALE (Size chart is not unisex! It is gender specific. Please review and choose carefully. For the girls, kindly double check and review the female size chart) SELECT EVENT TYPE & CATEGORY Event Type / Category * - Select -LONG - MALE 24 AND UNDERLONG - MALE 25-29LONG - MALE 30-34LONG - MALE 35-39LONG - MALE 40-44LONG - MALE 45-49LONG - MALE 50 AND ABOVELONG - FEMALE 29 AND UNDERLONG - FEMALE 30-39LONG - FEMALE 40 AND ABOVELONG - RELAYSPRINT - MALE 29 AND UNDERSPRINT - MALE 30-39SPRINT - MALE 40 AND ABOVESPRINT - FEMALE 34 AND UNDERSPRINT - FEMALE 35 AND ABOVEFUN - MALE OPENFUN - FEMALE OPENSTK - MALE 6-8STK - MALE 9-10STK - MALE 11-12STK - MALE 13-16STK - FEMALE 6-8STK - FEMALE 9-10STK - FEMALE 11-12STK - FEMALE 13-16 Gender * - Select -MaleFemale PLEASE READ FOR RELAY REGISTRATION: RELAY IS A THREE OR TWO MAN TEAM WITH AT LEAST ONE OPPOSITE GENDER. EACH MEMBER MUST REGISTER INDIVIDUALLY BUT WITH CONSISTENT "TEAM NAME" AND "CATEGORY" WITH OTHER MEMBERS. RELAY IS OPEN TO ALL AND NOT EXCLUSIVE TO ZAMBOANGA DEL NORTE RESIDENTS. PAYMENT METHOD / REGISTRATION PROCESS: Please follow these steps to complete registration. Fill-up this online registration form. Deposit payment to any BPI branch to: Account Name: ROBERTO T. UY, JR. Account Number: 001823-1257-86 On your deposit slip, write down your Registration ID then scan or take a photo of it and email to email@example.com. Final processing may take 3 to 5 working days before your name appears in the participant list. WAIVER / RELEASE FORM: In consideration of my entry, I, my heirs, executors and administrators release and forever discharge Dipolog City and Sugbutriathlon, its officers, staff, sponsors, servants, agents and subcontractors, instrumentalities, and all voluntary community groups, and all organizations assisting this event, producers, their agents and representatives of all liabilities, claims, damages or cost, which I may have against them arising out of, or in any way connected with my participation in this event. I understand this waiver includes claims based on negligence, action or inaction of any above parties. I fully recognize the difficulties of this event and declare that I am physically fit and able to compete in this event safely, and not have been told otherwise by a medically qualified person. Furthermore, I certify that I have secured for myself a life and accident insurance coverage up to the third party liability to answer for any damages or loss of life and property that may occur in this particular event. I grant the Organizers/Sponsors full permission to use his/her photographs and/or motion pictures, recordings or other records of the Event featuring the undersigned for any legitimate purpose, including commercial advertising. I also understand that this registration is non-transferable and non-refundable. I agree that in the event of race cancellation due to storm, rain, inclement weather, wind or any other unforeseeable, or “act of God” conditions, my entry fee shall be non refundable. If I am under 18 years old, my guardian is signing this form on my behalf and is the one filled in the Emergency Contact Person field. I represent and warrant the organizer that I have full legal authority to complete this event registration on behalf of myself and/or any party I am registering for. I have carefully read this entry form and agree to abide by all rules and directions of all race officials on the day of the race. CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. What code is in the image? * Enter the characters shown in the image.