The Fresh Choice Nelson City Musselman ENTRY FORM

  • Entry Fees are listed below.
  • A Late Entry Fee of $25.00 per person applies to entries received after the 22nd October 2010.
  • Each entry form is to be filled in and signed by each competitor.
  • Photocopies accepted.
  • Entries Close 27th October 2010.
  • No race day entries.
Individual Name:  
Address:  
Date of Birth (minimum age 15)  
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) Multisport – Duathlon – Short Duathlon – Cycle Odyssey
Teams: (circle) Mens – Mixed – Womens – Tandem
Team Name:  
Team Captain:  
Kayakers Name:  
Road Cyclists Name:  
Mountain Bikers Name:  
Runners Name:  
Entry Fees $NZ
Multisport Indivduals $70.00
Long Duathlon $50.00
Short Duathlon $30.00
Cycle Odyssey $50.00
Tandem Teams $70.00 per person
Teams $40.00 per person
Early Bird Entry fee applies until 30th September 2010 - $10.00 per person
   
Late entry Fee $25.00 per person
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 in The Fresh Choice Nelson City Musselman 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.

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)

(75% refund will be given to teams withdrawing before the 22nd October 2010)

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 account02-0704-0044538-000, code as ADV Mussel and your name, then still post your entry forms to ADVENTURE NELSON, PO Box 362 Nelson.