Entry Form - 5th May 2012
Instructions: Read the race details carefully, then print this form, fill it in clearly,
and mail it with payment to:
Hanmer Half Marathon, PO Box 103, Hanmer Springs., to arrive by Monday 30th April 2012.
Make cheques payable to "Hanmer Springs Multi Sport Club" or or pay on line into the following account: 02 0876 0136404 02 (please identify yourself in the Notes). One entry per form please.
| Name: | __________________________________________________________ |
| Street Address: | __________________________________________________________ |
| Postal Addess: | __________________________________________________________ |
| Phone No: | _________________________ | Mobile: | _________________________ |
| Age on race day | ________________________ | M / F | |
| Email: | __________________________________________________________ |
| HALF MARATHON @ $35.00 p/p |
| JUNIOR MEN (18 & under) $20 | [ ] | | JUNIOR WOMEN (18 & under) $20 | [ ] |
| MEN OPEN | [ ] | | WOMEN OPEN | [ ] |
| MEN VETS 40+ | [ ] | | WOMEN VETS 40+ | [ ] |
| MEN MASTERS 50+ | [ ] | | WOMEN MASTERS 50+ | [ ] |
| MEN CLASSICS 60+ | [ ] | | WOMEN CLASSICS 60+ | [ ] |
| SUPER CLASSICS 70+ | [ ] | | WOMEN SUPER CLASSICS 70+ | [ ] |
| MEN WALKERS | [ ] | | WOMEN WALKERS | [ ] |
| 10km FUN RUN AND WALK @ $30.00 p/p |
| JUNIOR MEN (15 & under) $10 | [ ] | | JUNIOR WOMEN (15 & under) $10 | [ ] |
| MEN OPEN | [ ] | | WOMEN OPEN | [ ] |
| MEN VETS 40+ | [ ] | | WOMEN VETS 40+ | [ ] |
| MEN MASTERS 50+ | [ ] | | WOMEN MASTERS 50+ | [ ] |
| MEN CLASSICS 60+ | [ ] | | WOMEN CLASSICS 60+ | [ ] |
| SUPER CLASSICS 70+ | [ ] | | WOMEN SUPER CLASSICS 70+ | [ ] |
| MEN WALKERS | [ ] | | WOMEN WALKERS | [ ] |
| Entry on the Day will be available for an additional cost of $10 |
Indemnity:
I understand that I am entering this event at my own risk. In my judgement I have sufficient competence, experience and fitness
to compete safely. I have the read and understood the conditions on the entry details and I agree to abide by these conditions
governing the running of the event. I agree to indemnify and hold harmless the organisers and sponsors from any and all liabilities
and claims made by other individuals and entities as a result of any of my actions, inactions, negligence or unacceptable behaviour
during the event.
I agree to attend and listen to the race brief prior to the start of the race, and obey all instructions given at this. I
understand that the race organisers will take all reasonable and practical steps to ensure my safety throughout the duration
of this event.
Signed _________________ Date _________________
Parent to sign for juniors _________________
