(Please Print) |
Event (please tick)  |
First Name: __________________________________________________________
Surname: __________________________________________________________
Address: __________________________________________________________
Suburb: __________________________________________________________
City: __________________________________________________________
Email: __________________________________________________________
Phone: __________________________________________________________ |
 Full Marathon Run
Full Marathon Walk
½ Marathon Run
½ Marathon Walk
10km Run
10km Walk
|
Male Female Marathon only: estimated time: ________________
Date of Birth: ______________ Age at race day: __________
(Full Marathon runners estimating to take more 5 hours must start together with the walkers at 7:30am) |
| |
Grade (Full Marathon entries only) |
Declaration (To be completed by ALL entrants. Entrants under the age of 16 yrs require parent or guardian signature.)
I declare that: I/We have read the race information and are aware that road rules apply at all times and there are no road closures. I am eligible to compete as an amateur under IAAF rule no. 53. My accepted entry will not be transferred to another runner/walker. In the event of an “ACT OF GOD” conditions causing a cancellation of the event, my total entry fee is NOT refundable. Neither the organisers, the sponsors nor other parties associated with the event shall have responsibility for any liability, financial or otherwise, which might arise whether or not by negligence from any direct or indirect loss, injury or death which might be sustained by me or any other party directly or indirectly associated with me, from my intended or actual participation in the event or its related activities. I authorise my name, voice or picture and any information on this entry form to be used without payment to me in any results, broadcast, telecast and/or promotion pursuant to the Privacy Act 1993.
Signature: ____________________________
Date: __________________ |
Open Men
Men 35 – 39
Men 40 – 44
Men 45 – 49
Men 50 – 59
Men 60+ |
Open Women
Women 35 – 39
Women 40 – 44
Women 45 – 49
Women 50 – 59
Women 60+ |
|
Quality Commemorative Shirt $35.00
Female fit size (please circle) 10 12 14 16 18 or
Male fit size (please circle) S M L XL 2XL |
Entry Fee Full marathon ($ 50.00): $ |
Entry Fee half marathon ($35.00): $ |
Entry Fee 10km ($15.00): $ |
Admin fee for registration after
August 20th ($10.00) $ |
Shirts at $35.00 each $
Order before August 20th! |
Payment Enclosed $
Make cheques payable to Run Walk Hawke's Bay and send with form to Race Secretary, Run Walk Hawke's Bay, P O Box 537, Napier. |
Have you ticked your event?
Have you ticked your grade (full marathon only)?
Have you circled your T-shirt Size (optional)?
Have you signed the declaration?
Have you made out your cheque to Run Walk Hawke's Bay? |
