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Team Registration Form

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					RELAY FOR LIFE

Team Captain Registration
Instructions to Team Captains:  Please fill in this form and the attached Team Member Details form  Send both forms to The Cancer Council Western Australia with a registration fee of $20 per team member (10 - 15 members per team).  If you don’t have all the personal details of your team members, register your team with the information you have.  We will follow it up with you before the event. Team Kits: After we receive these forms and registration fee, we will send a team kit to the Team Captain including t-shirts ( as soon as available) for each team member and fundraising support material. Additional materials will be handed out at Team Captains meetings and the Relay For Life event. CONDITIONS OF ENTRY
Team Captain’s MUST SIGN this registration form to participate in Relay for Life as acknowledgement and acceptance of the waiver outlined below. (Team members refer to Team Registration Form) WAIVER: In consideration of this entry being accepted, I understand, intending to be legally bound for myself and my heirs, executors and administrators,I waive and release the organisers and sponsors (individually and collectively), including the directors, officers, staff, volunteers and representatives thereof, and indemnify them against any liability (including liability and negligence) for the death or any physical or mental illness, incapacity or property damage or loss I may suffer which may directly or indirectly result from my participation in the event. I further verify that I am in proper physical and mental condition to participate in the event and acknowledge that I am aware of the risks involved and voluntarily agree to assume those risks. Signature_____________________________________________________________Dated________________________

Event Name:……………………………………………………………………………………………… Team Captain First Name:.............................................. Last Name ........................................................ Team Name: ............................................................................................................................................. Club/Employer/Organisation (if applicable): ........................................................................................... Delivery Address:..................................................................................................................................... Postal Address: .......................................................................................................... P/Code ................. Telephone Work: ................................... Home: ...................................... Mobile: .................................... Email: ...................................................................................................... Fax: ......................................... Registration Fee $20 (incl GST) per team member includes T/shirt (Fee not refundable or tax deductible)

Office Use Only: Donor # _____________Receipt Bks No______________Dep Bk No_______ ______________________________________________________________________________ Payment Details: Registration Fees $__________________ Additional T/shirts $__________________ Total Payment Method of Payment: Cash  Cheque  Visa  Mastercard  $__________________

(Makes cheques payable to The Cancer Council WA)

Credit Card No: ______/______/______/_____

Expiry Date:

_____/ ______

Name on Card:__________________________Signature:______________________ OR post your cheque to:

Relay for Life
46 Ventnor Ave WEST PERTH WA 6005

PTO 

T-SHIRT ORDERS. Please indicate sizes and number of T/ shirts your require for your team. Additional T-shirts are $12.00 each and can be included in this order. Sizes & Quantity:

XS

S

M

L

XL

XXL

XXXL

PREVIOUS PARTICIPANT: (Please Tick) Team Captain  Team Member  Volunteer  Committee Member 

HOW DID YOU HEAR ABOUT RELAY (Please Tick) Word of mouth ................  Friend or family ...............  Website ..........................  Email ..............................  Direct Mail .......................  Poster .............................  Newsletter .......................  TV ..................................  Press ..............................  Radio .............................. 

Other (please escribe)_________________________________________

Your name and address details may only be used to keep you better informed of The Cancer Council Western Australia activities and services. If you DO NOT wish to receive this information please mark the box NO MAIL box on registration.
NO MAIL please



CONTACT DETAILS: Relay Hotline: 1300 65 65 85 Lorri Carroll 9212 4323 Fax: 9212 4334 lorri@cancerwa.asn.au relay@cancerwa.asn.au Website: www.cancerwa.asn.au


				
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posted:11/9/2009
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