West Wight Triathlon - Individual Entry

Please complete the details below.  
You select your entry fee on the next page

- Required field

First Name
Last Name
Address 1
Address 2
Address 3
Town
County
Postcode
Phone No.
Mobile Phone
Email Address
BTA Number (essential if claiming a lower entry fee)
Club Name
Date of Birth Participants must be 15 or over (team swimmers 12 or over) on 31/12/07	12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember  1933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996
Gender	Please selectFemaleMale
Predicted Swim Time
Predicted Bike Time
Predicted Run Time
Do you have any medical conditions?
Interesting information: e.g.: charity, first timer, target, other reason. Note: This may be used during our race commentary and/or press releases
Submitting this form implies acceptance of the following disclaimer: I/my team enter entirely at my/our own risk and agree that the organisers will in no way be held responsible for any injury, illness or loss incurred to person or property as a result of this event.
- Required field