Jane Tomlinson's Walk for All_ Yorkshire Dales - Registration Form by hedongchenchen

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									                               Friends of the Children Foundation
                              “Walk for Monash Children’s”
                Feb 2013 Walk Registration starts 8.30 am SHARP
                 24th
   Jells Park Oak picnic Area Mel ref 72-A9 (enter from Ferntree Gully road)
                         Registration Form


Family Name                               First name

Male / Female                             Registration paid by cash or transfer?

Address

                                                       Postcode

Home tel.                                              Mobile tel.

Email

Which distance do you wish to take part in?


 5K                                  10K                                   15K


STATEMENT OF RESPONSIBILITY AND WAIVER (All participants must sign.)
I certify that I am sufficiently fit to participate in this event over the distance I have selected. I
understand that participation may involve risk to me and by participating in this event I accept such
risk. I will conform with all safety, housekeeping and other instructions given by the organiser. In
consideration of this entry being accepted, I waive all claims which I might otherwise have against the
organiser or any individuals or entities associated with the conduct this event and agree to hold each
of them harmless for any injuries which I may suffer as the result of my participation. I give permission
for my name and image to be published in association with this event.


Signed:                                                              Date:


              Thanks for your assistance and in raising sponsorships for the walk.
      Please return completed form to: FOTCF Team member or email to fotcf@hotmail.com
           11 Winifred Street, Oakleigh Victoria 3166 Tel 03 9564 8228 Mob. 0411415490
                                     www.friendsofthechildren.net
  Except registration fee of $15.00 all donations over $2 are TAX DEDUCTABLE, receipts provided
                               Friends of the Children foundation inc
                                   (A0050462F ABN 45959017245)

								
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