Birmingham Adults Entry

First Name

Last Name

Comfirm Email

Contact Number

Emergency Contact Number

Date of Birth

Fundraising Target (£75 min, start your fundraising whenever you like!)

Distance

Estimated Swim Time (Minutes)

Select your Charity

Take part as a team?
Select Yes if you would like to take part as a team of 2, 3 or 4 friends

Team Name
This must match other team members Team Name exactly

Upload a picture for your fundraising page (Jpg Only)(5mb Max)

Commentator Info (Max 100 Characters)
This will be announced as you cross the finish line

Characters remaining: 100

Why do you want to take part and raise money?
This will be displayed on your fundraising page

By ticking this box you accept our Terms & Conditions.

Distance	Swim	Bike	Run
Fun Challenge Triathlon	100m	3km	1km
Endeavour Triathlon	150m	4km	2km
Venture Triathlon	200m	5km	3km