Run    or    Walk    (circle one)

Team captain

Address

Phone                                                    Mobile      

email

Team Members Names (remember each team must have at least one female member)

Return the completed form with payment to:  Orewa Events 65b Centreway Rd Orewa Beach and we will send you confirmation by email. Entries close 30th September

$120.00 4 person team ($30.00 each)

$60.00 2 person team ($30.00 each)

To Register for this event you must read, understand and agree to all the following terms and conditions:

DECLARATION

I understand that I am entering this event at my own risk. I agree to read and adhere to the race instructions.

I hereby consentI to receive any medical treatment which may be deemed advisable during the event.  I agree to receive and pay for at the request or direction of the organizer before, during or after the event.

I agree to have my photographic image used in future event publications and websites by the event organizer.             

Signature of each team member:  **Must be signed by a parent or guardian if under 16 years of age**

Date:  __________________

All entries are non-refundable 2 weeks prior to the event due to administration costs.