Lodge to Lodge Entry Form

Select your event.
Event:

One entry per form please. Only relay people fill in both.
Name:
Street Address:
Town:
Postal Address:
Phone Number:
Age (on race day):
Email:
Relay people fill in this part.
Name:
Street Address:
Town:
Postal Address:
Phone Number:
Age (on race day):
Email:
I would like to use transport from Waiau to Mt Lyford/Wandle River in the morning (7.30-8.30 am) at an extra cost of $5 pp.
I understand that I am entering this event at my own risk. In my judgement I have sufficient competence, experience and fitness to compete safely. I have the read and understood the conditions on the entry details and I agree to abide by these conditions governing the running of the event. I agree to indemnify and hold harmless the organisers and sponsors from any and all liabilities and claims made by other individuals and entities as a result of any of my actions, inactions, negligence or unacceptable behaviour during the event. I agree to attend and listen to the race brief prior to the start of the race, and obey all instructions given at this. I understand that the race organisers will take all reasonable and practical steps to ensure my safety throughout the duration of this event.
2 + 2 =