2008 Harbor Lights Triathlon
Request for Medical Roll-Over


If you are unable to compete due to injury or illness then you may qualify for a medical transfer to next year’s event. As is clearly stated in our registration materials, there will be absolutely NO REFUNDS.

In order to qualify you must:
• fill this form out completely, and
• attach a note from a health care professional

All materials must be postmarked no later than two (2) weeks after the race. All roll-over requests and inquiries will be handled by the Registration Coordinator. All decisions made by the Registration Coordinator are final.

Please mail to:
CAPRI Events - Medical Roll-Over Request
PO Box 577490
Chicago, IL 60657-7490

Category
(you must check one)

O Individual, Open Age Group
O Relay Team


Name:____________________________________________________________

Address:__________________________________________________________

City:____________________________ State:__________ ZIP:______________

Daytime Phone:____________________________________________________

Email:____________________________________________________________
Please print clearly and provide all of the
information requested above.
Incomplete requests will not be considered!