Autumn 102 & 51 entry form « Adventure Nelson

Autumn 102 & 51 ENTRY FORM

Entries are no longer being taken for this events
Entries are closed

Individual Name:
Address:
Date of Birth (minimum age 16)
Sex M / F:
E-mail:(print clearly)
Contact phone:
Class: (circle)Vets are 40+	Open Men – Open Women – Vet Men – Vet Women – Under 20
Category: (circle)	Autumn 102 – Autumn 112 – Autumn 100 – Autumn 68 – Autumn 58 – Autumn 51
Teams: (circle)	Mens – Mixed – Womens
Team Name, Captain and contact:
Swimmers Name:
Kayakers Name:
Road Cyclists Name:
Runners Name:

Entry Fees for	Autumn 102 – Autumn 112 – Autumn 100
Early Bird entry for Individuals and per Team - applies until 14th March 2010	$
Individual and per Team- applies from the 15th March 2010	$

Entry Fees for	Autumn 68 – Autumn 58 – Autumn 51
Early Bird Individuals and per Team- applies until 14th March 2010	$
Individual and per Team – applies from the 15th March 2010	$


Late entry Fee – all entries after 1st April 2010.	$
Total Amount paid:

Is there anything else pertaining to your health that we should know about ?
Name, address and phone number of the person we contact in case of emergency.

Wavier

I certify that I am physically fit to compete within my selected category at Autumn 102 & 51 and have not been advised otherwise by a qualified medical person.
I agree to compete in the spirit of the event and have read, understand and agree to abide by the race rules, and accept any decisions made by the race organisers as final.
I acknowledge that all roads are open and will abide by the road rules at all times.
I agree to compete at my own risk and waive liability against the race organisers, race officials, landowners and sponsors for personal injury, death, loss of personal equipment, or damage to 3rd party property that may result as a consequence
of my involvement in this event.

Should the weather or any unforseen conditions see or cause the race to be cancelled there will no refunds given. There in an alternatives course inplace refer to the race details.

I agree that the information collected with this entry may be held by Adventure Nelson Ltd and NARC to provide me with with information on future adventure racing / triathlon or multisport events.
Name:____________________ Signature: _________________ Date:_____
(Team captain to sign entry form on behalf of the team)

Adventure Nelson Refund Policy

A 70% refund will only be given to those withdrawing before the 1st April 2010 or there entry fee can be credited towards another Adventure Nelson event. After the 1st April no refunds or event credits will be given.

Make cheques out to Adventure Nelson Ltd and post to
ADVENTURE NELSON, PO Box 362 Nelson.

Or pay online, direct credit your entry fee into the Adventure Nelson Ltd bank account 02-0704-0044538-000, code as Autumn 102 and your name, then still post your entry forms to ADVENTURE NELSON, PO Box 362 Nelson.