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~Entry Form~
Instructions: Print this form, fill it in and mail with payment to:
Whenuapai Half Marathon, PO Box 79 132, Royal Heights, 0656 Auckland. See note below on electronic payment
PLEASE Print clearly in BLOCK LETTERS
Your Details:
| First Name: |
______________________________________ |
| Surname: |
______________________________________ |
| Postal Address: |
______________________________________ |
| |
______________________________________ |
| |
______________________________________ |
| Email Address: |
______________________________________ |
| Telephone: |
__________________ |
Sex: |
M  F |
Half Marathon Walk
Half Marathon Run
10km Walk
10km Run
6km Entrant
Declaration:
I declare that:
- I am eligible to compete as an amateur under IAAF rule 53.
- I will be 16 years of age (for the Half Marathon/10km) or older on 5th April 2009.
- My accepted entry will not be transferred to another person unless the transfer fee has been paid in full.
- In the event of any "Act of God" causing a cancellation of the event, or personal circumstances preventing me
from running, my total entry fee is non-refundable.
- I hereby release the event committee, their officers, directors, volunteers, sponsors or any party associated with
the event of 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 and its related activities.
- I hereby permit the free use of my name, voice or picture to be used in any broadcast, telecast, advertising,
promotion or in any other way relating to this event pursuant to the Privacy Act 1993.
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| Signed: | _________________________________ |
| Signature of parent/guardian if under 18: | _________________________________ |
Entry Fees:
(Prior to and including 1st April 2010)
| Half Marathon | $40.00 | _______ |
| 10k | $30.00 | _______ |
| 6k | $10.00 | _______ |
| Late Entry (Half Marathon / 10k) | ADD $10.00 | _______ |
| | TOTAL: | _______ |
| Tick if paid online |
Electronic payment:
You can pay entry directly to our bank account ASB 12-3085-0165595-000
Enter your surname and first initials at PARTICULARS e.g Anderson John
enter ANDERSONJ: amount paid in dollars (see entry form for the correct
amount to be paid) at CODE eg 35: at REFERENCE enter the event entered
eg. HALFRUN (alternatively HALFWALK or 10KMRUN or 10KMWALK or
6KMRUN or 6KM WALK)
You must still sign and date the declaration form and post in for your entry
to be valid.
Example: Particulars: ANDERSONJ Code: 35 Reference: HALFRUN
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