Are you attending this event?

Yes No Maybe

Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Sport Ident Number (if using your own)

Paid Online ?*

Yes

No

Amount Paid*

Member entry $ 13

Member entry own Sport ident $10

Member part of family entry max $30

Member part of family entry Own SI max $25

NON Member entry $ 18

NON Member entry own Sport ident $15

NON member part of family entry $45

Hazards could include Rough ground, waterways and maybe some animals.

I confirm that I have read the above Event Waiver in its entirety.*

I agree to the Event Waiver.*

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