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September 18th, 2010

Fill out entry form, print and send by mail

Duathlon 3/33/3 individual $60
Duathlon 3/33/3 team $80
TRIATHLON QUEBEC ADDITIONAL NON-MEMBER FEES: INDIVIDUAL +10$

TRIATHLON QUEBEC ADDITIONAL FEES:
TEAM DUATHLON +10$
Last Name:
First Name:
Address:
City:
Province :
Postal Code:
  
Country :
Phone:
 ( ) - -
Email:
Birthday :
Year   Month   Day
Age on december 31st :

  years
Sex :
 Man
Woman
 
T-shirt :
 
# Membre Triathlon Québec :
Fédération :
 
Credit card
(Visa and Mastercard):
 ---  Exp: / (MM/YY)
  + Fees 5$ Visa and Mastercard
Total:
  
 
Team Section only
Team's name:
Select a category :
Men Women Mixed
Cyclist:
Cyclist t-shirt:
Runner:
Runner t-shirt:
  • Option 1:
    Send by fax with Visa or Mastercard # to (450) 227-3578
    (add 5$ to entry)
  • Option 2:
    Send by mail with cheque to:
    SporTriple 1139, chemin de la Paix Saint-Sauveur Qc. JOR 1R2

 
 

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