Rollo’s Nelson Adventure Race 2010 entry form

 

Team Name:  
Event entered: Adventure Race or Adventure Duathlon (please circle) 
Categories: Adventure Race AR24-4 person, AR24-2 person, AR12-4 person, AR12-2 person 
Categories: Adventure Duathlon AD24-4 person, AD24-3 person, AD24-2 person,AD12-4  person, AD12-3 person, AD12-2 person
Team Captain:  
Name:  
Address:  
Sex M / F  
Date of Birth: (minimum age 18 years, needs to be approved by the Race Director)  
Contact Phone number:  
E-mail address: Please print clearly  
Previous Rollo’s Nelson Adventure Races: (circle)  2001 – 2002 – 2003 – 2004 – 2005 – 2006 – 2007 – 2008 – 2009
Previous Race Experience:  
Rate yourself in experience and expertise in the following: (1-poor to 10 – expert)  Kayaking_____ Navigation_____ Mountain Biking_____Swimming_____First Aid_____Trekking______
 E-mail:(print clearly)  
Medical Information  
Are you currently taking any medication?If so please specify the types and amounts?  
Are you allergic to any medications?If yes please specify.  
 Have you been treated for any serious illness within the last 3 years?If yes, please specify.  
 Is there anything else pertaining to your health the we should know about?    
Name, address and phone number of the person we contact in case of emergency.  
   
   
Official use only  
Date Banked:  
Total Amount paid:  
Internet banking:  
Cheque:  
Cash:  

Wavier

I certify that I am physically fit to compete within my selected category of the Rollo’s Nelson Adventure Race 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 unforeseen conditions see or cause the race to be cancelled there will no refunds given.

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 75% refund will only be given to those withdrawing before the 15th May 2010 or your entry fee can be credited towards another Adventure Nelson event. From the 15th May 2010 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 RNAR 12/24 and your name, then still post your entry forms to ADVENTURE NELSON, PO Box 362 Nelson.