KIDS TRIATHLON ONLINE REGISTRATION
Last Name     First Name  
Address       City  
State    Zip     Telephone (Include Area Code)
Sex    Age      Date of Birth  
USAT Number   
Race Category      
Credit Card Type    Account Number    Exp  3 Digit Security Code 
Shirt Size

 
       
 
Entry Fee
$40

Registration ends June 13, 2012 at midnight
No Refunds
Race Total                  USAT Total  
NOTE :  All participants must have a USAT Membership or purchase a one day pass. Kids one day pass is $15.   
If you are purchasing a one day pass, you must enter the words ONEDAYPASS in the USAT number field on this form.
USAT raised the rates as of January 1, 2012.  We have no control over this fee, and it is mandatory for racing.
   

All athletes must read and sign the Waiver & Release form at packet pick-up (parent or guardian if under 18). 
Parent's drivers license and proof of USAT membership will be required.

By submitting this form, I authorize the Heartland Triathlon to charge my credit card.

E-mail Address  

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