INSTRUCTIONS:

Complete on-line, submit and pay into our bank account (noting your surname as a reference)

OR

Print out the form below complete and post with payment to (cheques also payable to):

Lactic Turkey Events,

PO Box 60-540,          

Titirangi,          

Auckland 0642

WE ARE UP TO 140 ENTRIES SO STILL PLENTY OF FREE SPACES! (14/1/10)

* Mandatory fields

E-mail:*
Address
First Name:*
Last Name:*
Phone
Age
   
Course*
21km 15km
 
Gender Category*
Men Women
Age Category*
Junior (Under 19) Open Veteran (40+) Super Veteran (50+)
     
How did you hear about this event?*
     
21km Run Entry @ $80
$16km Run/Walk Entry @ $65
Total Paid*
Payment Method*
Cheque

Direct into Lactic Turkey Bank - Please pay into our Kiwi Bank account called "Lactic Turkey Events Limited" Account number 38-9005-0018737-00

Credit Card - you'll have a chance to pay by credit card on the next screen once you have submitted this entry info

Date Paid
Reference of Payment

Participant Declaration* I have read, understand and agree to the Participant Declaration below
Enter me into the Wild Turkey now!

Confirmation of entry is by e mail when payment is received

Event organisers reserve the right to combine grades if insufficent numbers are entered.

Participant Declaration:

I declare that I have fully read and understand the rules and conditions of the Wild Turkey Off Road Half Marathon and/or 16km. I attest that I am fully aware of the risks and hazards involved in participating in this event and I understand that participation in the event is at my own risk. In consideration of the acceptance of my entry fee, I do hereby on behalf of my heirs, executors, administrators and assignees release and forever discharge the sponsors of, landowners and any and all persons involved in the conduct of the Wild Turkey Off Road Half Marathon and/or 16km from any and all liability whatsoever or claims of damages or actions whatsoever (including negligence) in any manner arising out of my participation in the Wild Turkey Off Road Half Marathon and/or 16km. I agree that Lactic Turkey Events and any sponsor of this event may use information contained in this form for purposes connected with the event, and to provide details of other products,  services and events to me from time to time. I understand that I have rights under the Privacy Act 1993 to access and correct any information held about me.

Refund Policy - Entries cancelled greater than two weeks before an event will receive a refund less a $10 administration fee. Entries cancelled within two weeks of the event can be used as a credit for another Lactic Turkey event or can be refunded less a $20 administration charge. No refunds will be given for cancellations within 48 hours of the event day. Refunds will be paid direct into a bank account as nominated by the participant.