Print & Post Entry Form

Instructions: Print this form, complete and hand in at: Spokesman Cycles, 61 Queen St, Blenheim; or post to: WB Half Marathon, SGT Mike Ettema, Log Sqn, RNZAF Base Woodbourne 7206. Please make cheques to Base Welfare Fund.
To enter on line and pay by credit card/debit card, please use the online entry form.

Name:	__________________________________	Email:	____________________
Address:	__________________________________	Phone:	____________________
	__________________________________	Age on Race Day:	____________________
	__________________________________	Gender:	M / F (circle)
Existing Medical Condition: ______________________________________________________
Yes I request confirmation of entry via email (tick):

Event Entered		(please tick one)
½ Marathon Run			$20
½ Marathon Hybrid			$20
½ Marathon Social Walk			$20
10km Fun Run/Walk			$5 (no late fee)
5km Fun Run/Walk			$5 (no late fee)
	Entry Fee:	___	(add late fee $10 after 07 Aug 11)

I agree to compete at my own risk and waive liability against the race organisers. I agree to attend and listen to the race briefing prior to the race start and obey all instructions given. I authorise my name, picture to be used without payment to me on any broadcast, promotion, or in any other way relating to this event pursuant of the Privacy Act 1993.
Signed:______________________________