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  • Hackney 2016 Runner Registration Form

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    Beau Zilesnick
    22 views2 pages
    This document appears to be a registration form for a half marathon taking place on May 8th 2016. It requests information such as the participant's name, address, phone number, email, date of birth, emergency contact, predicted finish time, medical conditions, and signature. The form notes that competitors must be at least 17 years old on race day and declares that the organizers are not liable for any injuries resulting from participation.

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    Hackney 2016 Runner Registration Form

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    This document appears to be a registration form for a half marathon taking place on May 8th 2016. It requests information such as the participant's name, address, phone number, email, date of birth, emergency contact, predicted finish time, medical conditions, and signature. The form notes that competitors must be at least 17 years old on race day and declares that the organizers are not liable for any injuries resulting from participation.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    22 views2 pages

    Hackney 2016 Runner Registration Form

    Uploaded by

    Beau Zilesnick
    This document appears to be a registration form for a half marathon taking place on May 8th 2016. It requests information such as the participant's name, address, phone number, email, date of birth, emergency contact, predicted finish time, medical conditions, and signature. The form notes that competitors must be at least 17 years old on race day and declares that the organizers are not liable for any injuries resulting from participation.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    SUNDAY 8th MAY 2016

    SURNAME

    FIRST NAME

    ADDRESS

    TELEPHONE
    CONTACT
    NO..

    PLEASE ADD MOBILE


    (for SMS race
    results)
    EMAIL

    OCCUPATION

    D.O.B
    DATE OF BIRTH..
    AGE ON RACE DAY... (N.B. All competitors must be 17 or over on the
    day)

    GENDER
    M / F (please circle)

    TECHNICAL T-SHIRT SIZE


    FEMALE: XS S M L MALE: S M L XL
    EMERGENCY CONTACT
    (on race day) EMERGENCY CONTACT NAME
    ..
    EMERGENCY CONTACT NUMBER

    PREDICTED FINISH TIME
    HRS MINS
    HOW MANY HALF MARATHONS HAVE YOU PREVIOUSLY PARTICIPATED
    IN? ..............
    DO YOU TAKE PART IN ANY OF THE FOLLOWING? (PLEASE CIRCLE ALL THAT
    APPLY)
    5K 10K MARATHON DUATHLON TRIATHLON
    WHATS YOUR REASON FOR RUNNING

    MEDICAL INFORMATION
    Please specify any conditions and medication that the race medical team should
    be aware of.
    Conditions
    .
    Medication
    ..
    It is your responsibility to declare any serious medical conditions to the Event
    Organisers and to record your medical details and emergency contact details on
    the reverse of your race number and to bring any necessary treatment with you
    on the day.

    WHERE DID YOU HEAR


    ABOUT THE EVENT?
    entry applications have been processed we cannot refund any entry fee. For a full copy of the events Terms & Conditions see
    www.runhackney.com

    DECLARATION: I declare that I will abide by the rules of UKA, I am over 18 years of age and accept that
    the organisers will not liable for any injury, loss, damage, action claim, costs or expenses which may
    arise in consequence of participation in this event. I declare that I will not compete in this race unless I
    am in good health on the day of the race and that in any event I will only compete at my own risk.

    SIGNATURE: . DATED:
    ...

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