ALL▴TRI: 2012 TRIbal Elder Registration Form

As a successful alumnus of the ALL▴TRI program, you have the unique opportunity to serve as a mentor to new participants in the program. Your encouragement and example can mean the difference between success and failure for a new member. Remember what your Elders did for you? Pay it forward! For a fee and a small commitment on your part, you can train with the group and benefit from the coaching, training tools and group camaraderie.

First Name: *

Last Name: *

Mailing Address: *

City: *

State *

ZIP: *

Phone: *

Email: *

T-Shirt: *

Birth Date: *
(mm/dd/yyyy)

Gender *

What Season(s) did you participate as an active fundraiser?: *
Fitness & Health Information
Currently I engage in sports or fitness activities: * Daily 1-2x a week Once a week 1-2x a month Rarely
Please list any recent athletic injuries or surgeries that may affect your training with ALL TRI: *
Please indicate how many of the following events you have completed in the past ten years:

Triathlons: *
(any distance)

1/2 Marathons: *

Marathons: *

Century Bike Rides: *

Please list any medical, health or allergy conditions that we need to be aware of: *
Please list medications you are taking that may be important in the event of a medical emergency: *
2012 TRIbal Elder Goal
What is your personal goal? *
(e.g. Finish the Event, Achieve a Personal Best, Qualify for a Race)
2012 TRIbal Elder Commitments
Be a Mentor: * You will be paired with a new fundraising TRIbe member who you will help guide through the fundraising process. Besides providing general cheer and encouragement you will attend the Fundraising Clinic with your mentee, help your mentee develop a Fundraising Action Plan, make weekly Fundraising Progress Checks and Report Fundraising Status to the Fundraising Coordinator. Train with the Team by attending the Team workouts and wearing the Team colors. You will be identified as a Team Elder and a Team resource for the fundraising members. Provide encouragement for the new tribe members.
(choose one)
Volunteer for ALL TRI: * Volunteer 20 hours during the season to promote ALL▴TRI through race participation, being a race volunteer (water stations, body marking, race check in etc) or promoting the program at the ALL▴TRI information tent at race expos and promotional events. Contribute to ALL▴TRI financial reserves through fundraising, donations and or sponsorships. Fundraising, Donations and Sponsorships may be in-kind but all must provide a minimum value of $500.
(choose one)
Emergency Contact Information

In case of emergency, please contact:

First Contact

First Contact Name: *

First Contact Phone: *

First Contact Relationship: *

Alternate Contact

Alt Contact Name: *

Alt Contact Phone: *

Alt Contact Relationship: *

ALL▴TRI Program Registration Fee: $150

This will cover coaching, insurance, pool rental and your use of the Training Peaks training tool (You will be responsible for any race expenses - entrance fees, travel, lodging, pre-race dinner, equipment and ALL▴TRI gear).

For each new fundraising member you recruit (up to three) to ALL▴TRI for the current season, your program fee will be reduced by $50. Bring 3, train for free!

You may securely pay via credit or debit card through PayPal after submitting this form digitally.
ALL▴TRI Participant Liability, Consent, and Information Release

I, intending to be legally bound, understand that I am voluntarily participating in the ALL TRI, Inc. (ALL▴TRI) philanthropy and fitness training program (the Program) and all of its activities including, but not limited to, training for and participating in with the Capital of Texas Triathlon (Sprint or Olympic) on May 28, 2012, or the US Open Toyota Cup Triathlon (Sprint or Olympic) on October 7, 2012, (collectively, the Event) at my own request and at my own risk. I acknowledge that I am aware of the risks inherent in training for and participating in the Event and certify that I am physically fit, have not been otherwise informed by any physician and know no restriction imposed on me by any physician that would in any way prevent me from actively participating in the Event.

In consideration of ALL▴TRI′s sponsorship of this Event and my being permitted to participate in the Event, I, on behalf of myself, my successors in interest, heirs, assigns, and representatives, herby fully release and hold harmless ALL▴TRI and its Officers, Trustees, agents, employees, volunteers, and any medical providers working for or on behalf of the Program, and representatives, successors, and assigns (be they individuals or organizations), together with their insurers and sponsors, (collectively, the Organization), of and from any and all liability, claims, damages, actions, and cause of action whatsoever on account of any loss, damage, or injury to person (including death) or any other loss or inconvenience whatsoever, suffered by me at any time hereafter arising out of my voluntary participation in this Event, whether resulting from the Organization′s negligence or otherwise (collectively, Liabilities).

I also give permission to the Organization for the free use of my name, image and voice in any broadcast, telecast, print account, or any other account in any medium of this Event (the Personal Release).

Consent & Information Release (Consent): I hereby grant permission to the Organization to render preventative or first-aid assistance or seek treatment or medical care that seams reasonably necessary, including hospitalization, for my health and well being. I also give permission to the Organization to use and disclose my personal health information (PHI) in the ways described in this form. I allow the Organization to use my PHI as necessary for purposes related to my treatment. I also all the Organization to give out my PHI to doctors, hospitals, ambulance companies, coaches, family members, and others involved in my care and treatment. My PHI may also be used and given out as necessary for the proper management and administration of the Organization.

This Release & Consent will be governed by and subject to the laws (except the choice of law principles) and exclusive jurisdiction of the courts of the State of Texas.
By initialing below, You acknowledge that you understand and agree to the above release. * I acknowledge that I understand and agree.
Initial Here: *
ALL▴TRI Endurance Event Agreement
As a volunteer supporting ALL TRI and its mission, I agree: * That I am 18 years of age or older To provide a $150 non-refundable registration fee with this registration That I have read and understood all information presented in this form in its entirety To train with ALL▴TRI for the 2012 Capital of Texas Triathlon or for the 2012 US Open Toyota Cup To meet the minimum TRIbal Elder requirements
(All must be checked in order to participate)

Name Printed: *
(Please type your full name)

Date Printed: *
(Please enter today's date)

By typing your full name below, You agree that this is valid as your signature. * I agree.

Signature: *

Date Signed: *

Type the two words: *