Triathlon Worlds Qualifier Survey – Lake Placid, NY

This survey will be used by USAT Deputy Director Tim Yount, for all pre-race and race day announcements. We appreciate your completing this form and returning it to the national office as soon as possible.

Athlete name: _______________________ Age as of December 31, 2002: _________

Phonetic Pronunciation of name (i.e., Yount = Yawn-t; give first and last name in the case the first name could be pronounced incorrectly): _________________________________

Occupation: _______________________ Company name or if self-employed, tell us what you are doing: _____________________________________________________________________

City where you are currently residing: ______________________ State: ________

City where you spent most of your time as a youth: _________________ State:________

Please list your top two performances from either last year or early this season:

Event Name: ________________________________ Event Date: ___________________

Age Group Place: ________________________ Overall Place if applicable: ______________

Master’s Finish Place if Applicable: ___________ Overall Time: ______________

Splits for this event: Swim ____________ Bike ___________ Run ____________

Additional notes that are important for us to know about your performance at this event (i.e, defeated 5 pros in the event or won the AG by ten minutes): ____________________________________________________________________________________________________________________________________________________________________________

Event Name: _______________________________ Event Date: ___________________

Age Group Place: ________________________ Overall Place if applicable: _______

Masters Finish Place if Applicable ___________ Overall Time: ______________

Splits for this event: Swim ____________ Bike ___________ Run ____________

Additional notes that are important for us to know about your performance at this event:

____________________________________________________________________________________________________________________________________________________________________________

Please indicate your fastest times for the following:

1600 meter or mile run time _______________

Fastest time for 5K run _________________

Fastest time for 10K run ________________

Fastest time for 40K in either a cycling time trial or in a multi-sport event __________

Fastest 1.5k swim time in multi-sport or 1650 yards in a pool _______________

Please list all other notable honors/official times for any high school/collegiate or post collegiate activities in sport. What sports other than the three in triathlon have you done competitively? ____________________________________________________________________________________________________________________________________________________________________________

Any other notable accomplishments or awards you have earned outside of sports since youth that is worth noting? ________________________________________________________________________________________________________________________________________________

Did you earn USAT All American status – first team or honorable mention – in 2001? If so, please let us know the finish place in your age group _______________

Please either email the answers to this form to USAT (tim@usatriathlon.org), fax: 719-597-2121 or send via US Postal Service to: 616 West Monument Street, Co Spgs, CO 80905 by JUNE 11 to ensure we are able to get this information into our data base. Thanks in advance for taking the time to complete this.