Your details

Surname: First Name:   Please use all 3 address fields so we can mail-merge Street Address: Suburb: City: Postcode: Phone: home:   business: Email:

Event Please select one ...	Half Marathon Run  Half Marathon Walk	11km Run  11km Walk
	Est. Time: hours minutes

Singlets Please select one ...

Female 10 12 14 16 18 Male S M L XL XXL

Race Packs

I will collect my singlet & event pack from (please select one)

	Stirling Sports Westfield St Lukes		Stirling Sports Westfield Manukau
	Stirling Sport 170 Queen Street, Auckland 9am-4pm Fri 24th 9am-2pm Sat 25th February		Stirling Sports Westfield Pakuranga
			Stirling Sports Westfield Shore City Takapuna

Packs collected at Stirling Sports stores will be available during store hours from Fri 24th until 2pm on Sat 25th Feb. Uncollected packs will be available on event day from 6:30am at the late entry desk, Orakei Domain.

Remittance

Fee for entry and singlet - on or before 10/02/12 $50.00 Late entry fee - after 10/02/12 $55.00

Declaration
(To be completed by all entrants)

I declare that:

1. I hereby release the event organisers, the event sponsors and any other party associated with the event of any liability of any kind whatsoever (including liability for negligence) which might arise from any direct or indirect loss, injury or death which might be sustained in connection with my actual or intended participation in the event and its related activities.
2. Should the event be cancelled or stopped for any reason, or should personal circumstances arise that prevent me from participating in the event or completing the event, I accept that my total entry fee is non-refundable.

Name: Date:

The personal details of all entrants will remain confidential but may be used by the sponsors for promotional purposes only.

I do / do not wish to be contacted in future regarding special promotions.