Registration: 2019 Grand Rapids Triathlon - CAPTAINS

myTEAM TRIUMPH is committed to providing racing opportunities for individuals with disabilities. In order to sustain these efforts, we are requesting your help with fundraising. These funds will not only allow us to purchase & maintain more equipment but will also allow us to provide more racing opportunities for our Captains. Each ANGEL will be requested to donate at least $25 for each event that they participate in. This donation field will show up in your registration, even if the event is full and you choose to be on our waiting list. Please note that in the past, most of our waiting list Angels have been activated closer to race day. Off course, if you want to donate more or create a FUNDRAISING PAGE with us, we would welcome that too. Every donation you make is tax-exempt and non-refundable.  Thank you for supporting us!

This EVENT IS CURRENTLY FULL and we are not allowing for any more registrations at this time. We apologize for this inconvenience, but would like to offer you to be added to our WAITING LIST. By registering here, you will be notified and given the opportunity to become an official participant should someone cancel their registration.

Please note that by proceeding with this registration, you will be required to make a minimum $25 contribution which is a non-refundable donation to our organization.

USER INFORMATION
Organization:
First Name: * 
Last Name: * 
Gender: * 
Male  Female  
Date of Birth (mm-dd-yyyy): * 
Email: * 
Confirm Email: * 
Phone (format: xxx-xxx-xxxx): * 
Address: * 
Address 2:
City: * 
State: * 
Zip: * 
Are there specific Angels you wish to team up with: * 
Yes  
No  
Shirt Size: * 
S  
M  
L  
XL  
2XL  
Primary diagnoses/injuries that resulted in your disability & any other pertinent information: * 
How long have you had your disability: * 
Since birth  More than 1 year ago  Less than 1 year  
Type of assistive device used: * 
None needed  Cane  Crutches  Walker  Wheelchair  
Ability to use a wheelchair: * 
None needed  Independent Manual  Independent Electric  Unable  
Transfer ability: * 
Independent  Requires Min Assist  Mod Assist  Max Assist  
History of seizures: * 
Yes  No  
Are you continent: * 
Yes  No  
Would you require any special feeding during the race: * 
Yes  No  
Height:
Weight: * 
Person Completing Registration - First/Last Name: * 
Relationship to Captain: * 
Self  Parent  Guardian  Friend  
Enter the Security Code: *  
I agree to the terms and conditions: *  
 Read Terms & Conditions

2153 Wealthy Street SE Suite 208  |  East Grand Rapids, MI 49506  |  (616) 855-1972

© 2019 myTEAM TRIUMPH West Michigan. All Rights Reserved. Designed By Synergy Marketing Solutions

Main Menu Mobile