Your Information (All Fields Required)

Your Name

Your Phone Number

Your Email

Your Address

Married or Attached? Kids?

Height

Weight

Birthdate

Occupation

Job Description

Known Health Issues

Average Hours of Sleep


Goals (All Fields Required)

Goal Race

Current Season Races

Last Season Races


Athletic Background

Swimming

When did you first start swimming?

Where do you swim?

Distance per week?

How far is the pool from your home/work?

How often do you swim?

Do you attend a Masters Program?
 Yes No

Best 800:

Best 1500:

Best 2.4 mile:

Pool Toys (IE: Pull Buoy, Kick Board, Hand Paddles, etc.):


Cycling

When did you first start cycling?

Where do you ride? Cycling routes?

How often do you ride?

Distance per week?

Do you own a bike trainer (IE: Computrainer, Kurt Kinetic, Cyclops, etc.)?
 Yes No

Does your bike computer have a cadence feature?
 Yes No N/A

Do you belong to a cycling club? If so, which?

What bike(s) do you own?

Power Devices:

Best 40KM/25 mile?

Best other times?


Running

When did you first start running?

Where do you run? Running routes?

Do you belong to a running club? If so, which?

Distance per week?

How often do you run?

Best 5k:

Best 10k:

Best half marathon:

Best marathon:


General Training

Do you own a heart rate monitor? (required)
 Yes No

Does your heart rate monitor have a computer interface? (required)
 Yes No N/A

A. T. Test Cycling:

A. T. Test Running:

Best Olympic distance time:

Best Half Ironman time:

Best Ironman time:


Time Available To Train (All fields required)

(IE: 1 hour in AM, 90 minutes in PM, etc.)


Monday:

Tuesday:

Wednesday:

Thurs:

Friday:

Saturday:

Sunday:

Current Group Training:

Basic Training Week:

Additional Comments:

How did you hear about TriPower MultiSports?


Terms & Conditions

I acknowledge that training for and/or participating in a triathlon, duathlon, cycling, swimming, running or any other endurance sporting event is an extreme test of my physical and mental limits and that such training and/or participation poses potential risks of serious bodily injury, death, or property damage. I have provided Mike Plumb with all information which in any way relates to or that could affect my physical health and attest that I am in good health and my physical condition has been verified by a licensed medical doctor.


Furthermore, in return for my participation in this program, I on behalf of myself and my heirs or executors I hereby:


a) WAIVE, RELEASE, and DISCHARGE Mike Plumb, his officers, directors, administrators, employees, consultants, coaches and agents from any claims, costs or liabilities for personal injury, illness, death or damages of any kind which I may have now, or at any time in the future, resulting from participation in this or any other program;


b) AGREE NOT TO SUE any of the persons or entities mentioned above for any claims, costs or liabilities that I have waived, released or discharged herein;


c) INDEMNIFY, DEFEND, and HOLD HARMLESS the persons or entities mentioned above from any claims made or liabilities assessed against them as a result of my actions.


Submission of this form is agreement to the above terms.


Initials: