Du the Lakes
Duathlon
And 5K!
Benefit for Two Smiles One
Hope
Saturday May 9, 2015 - 8:30am
Green Lakes State Park
Fayetteville, New York
www.duthelakes.com
Duathlon Registration Fees**
5K and COMBO Hillbender
Fees
$55 Before April 1st
$65 After April 1st & on race day
$80 Per Relay Team (2 person)
(Entry cap of 250 participants)
Last Name: _____________
5K - $25
Duathlon and Caz Hillbender - $90
5K and Caz Hillbender - $60
First Name: _________________________
Address: ___________________________________________
City: _____________________________
Daytime Phone: _________
Email: ____________________
Gender: M / F
Zip: ______________
Evening Phone: _______________
USAT # __________________
Age on 12/31/2015: _____ DOB: __________
Arm Warmer size(s): (
Relay*: Y / N
State: ________
) Small/Medium (14 in.)
(
) Large/XL (17 in.)
Name of Team: _________________________ (Relay Fee is $80)
Runner: _______________________ Biker: _______________________
_____ YES! I would like to make an added donation to Two Smiles One Hope in
the amount of $__________. Please include it in my race fee registration.
* Relay team members must send their registration forms in together.
** If athlete is not a USAT member, please include $12 for a one-day license for 18+ and
$10 for 17 and under.
Mail Checks to:
Score This!!!, Inc.
15 Ranch Trail Ct.
Orchard Park, NY 14127
Please make checks payable to Score This!!!,
Inc.