10k Run, 5k Run and Walk

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					 10k Run, 5k Run and Walk
     Sunday 11th November 2007
UWS Macarthur, Narellan Rd Campbelltown.

        Campbelltown City Council                                                                                                                             Chest Number

Fisher’s Ghost Fun Run 2007 - Entry Form
Tick the event you will compete in                      10k                 5k                                                                                                                          Office Use Only

Surname:                                                                                                                     PRIVACY STATEMENT The information requested by
                                                                                                                             Council on this form may constitute personal information un-
                                                                                                                             der the Privacy and Personal Information Protection Act 1998.
                                                                                                                             Council is allowed to collect the information from you to consid-
First Name:                                                                                                                  er this matter. Supplying this information is voluntary. However,
                                                                                                                             if you cannot or do not wish to provide the information, we may
                                                                                                                             not be able to consider the matter. If you need further details,
                                                                                                                             please contact the Privacy Officer, Campbelltown City Council,
                                                                                                                             cnr Queen and Broughton Streets, Campbelltown.
        Male                    Female                          Age on race day                                              RISK WARNING Participating in a fun run or walk has cer-
                                                                                                                             tain risks associated with it, especially if the participant is trying
Postal Address:                                                                                                              to run/walk greater distances than he or she normally does, or
                                                                                                                             if the weather conditions on the day are particularly adverse.
                                                                                                                             Along with the usual risks of running/walking, such as the pos-
                                                                                                                             sibility of missing one’s footing, stumbling, or suffering from
Suburb:                                                                                        Postcode:                     muscular or other damage to legs and feet, participants may
                                                                                                                             suffer from exertion or from the heat of the day.
                                                                                                                             WAIVER DECLARATION THIS ENTRY FORM IS NOT
                                                                                                                             VALID UNTIL THE WAIVER DECLARATION HAS BEEN SIGNED I,
Day time phone number:                           Mobile:
                                                                                                                             the undersigned, hereby declare that I am in good health and
                                                                                                                             not suffering from any known illness or ailment and I agree,
                                                                                                                             as a condition of my entry in the Campbelltown City Council
                                                                                                                             Fisher’s Ghost Fun Run, for myself, my heirs, executors and
TEAM ENTRANTS:                                                                                                               administrators to waive all and any claim, rights or cause of
                                                                                                                             action which I or they might otherwise have arising out of any
If you are entering as a member of a team tick one of the boxes below:                                                       loss of life or injury, damage or loss whatsoever which I may
                                                                                                                             sustain in or as a consequence of my entry or participation in the
     Primary School
    Primary School                  Female
                                    Female                         Male
                                                                   Male                         Corporate
                                                                                                Corporate                    said event. I agree to abide by the event rules and conditions. I
     (5km only)                     (10km only)                    (10km only)                  (10km only)                  acknowledge that I enter the said event AT MY OWN RISK.
Team Name:
                                                                                                                             SIGNATURE OF ENTRANT:


                                                                                                                               IF YOU ARE 17 OR UNDER, YOUR PARENT OR

                                FREE T-SHIRT:                                                                                  GUARDIAN MUST SIGN HERE I certify that I am
                                                                                                                               the parent or guardian of the entrant who is under 18
                                                                                                                               years of age. I have read the aforementioned Risk Warning
                                         Tick Your Size                                                                        and the entrant has my consent to participate in the event
                                       (stocks may be limited)                                                                 in accordance with the aforementioned Declaration.

                                                                                                                               SIGNATURE OF PARENT OR GUARDIAN:

                    X-Small          Small             Medium                Large              X-Large                             ................................................................................

                                                                                                                                RETURN YOUR COMPLETED ENTRY
           Make cheques and money orders payable to Campbelltown City Council                                                     FORM WITH YOUR ENTRY FEE
 ADULT $20                    CHILDREN (under 16 years) $12                      FAMILY (max 3 children)       $50           BY MAIL
Fees are non-refundable                                                                                   (includes gst)       The Organiser
                                                                                                                               Campbelltown City Council Fisher’s Ghost Fun Run
                                                                                                                               c/- Campbelltown City Council
                                                                                                                               PO Box 57
 I enclose:                       Cheque                                                  Amount $..................           CAMPBELLTOWN NSW 2560

                                                                                                                             BY FAX
                                  Money Order                                             Amount $..................
                                                                                                                               Complete entry form with your credit card
                                                                                                                               details, fax to Campbelltown City Council
                                                                                                                               on FAX NO: 4645 4681
 OR please debit my:              Bankcard            Mastercard                 Visa Amount $.................
                                                                                                                             BY HAND
                                                                                                                               The Fun Run Display Unit
 Card No.                                                                                                                      MACARTHUR SQUARE SHOPPING CENTRE
                                                                                                                               (opposite Freedom)
 Expiry date              /                (All credit card payments will incur a Merchant Service Fee surcharge of 0.75%)
                                                                                                                               SEE NEXT PAGE FOR DISPLAY UNIT HOURS

                                                                                                                               The Cashier on the Ground Floor of
                                                                                                                               CAMPBELLTOWN CIVIC CENTRE
 Cardholder’s Name:                                                                                                            Cnr Queen & Broughton Sts, Campbelltown
                                                                                                                               HOURS: 8.30am - 4.15pm weekdays

 Cardholder’s Signature:                                                                                                       Customer Service Centre at EAGLE VALE CENTRAL,
                                                                                                                               Emerald Drive Eagle Vale
                                                                                                                               HOURS: 9am - 8.30pm weekdays
 Contact Phone Number:                                                                                                                   7.30am - 2.30pm Sat/Sun
                                                                                              cashier use only: FG003
                                  10k Run, 5k Run and Walk
                                  Sunday 11th November 2007
                                  UWS Macarthur, Narellan Rd Campbelltown.

                                 RETAIN THIS SHEET FOR YOUR REFERENCE

     Entering the Event                 Getting to The Event
                                                                    C                          s
ENTER IN PERSON                         BE EARLY                                          s.

                                                                   Throughout The Day...
                                                                  CAR PARKING

                                                                  BAGGAGE MINDING
                 .                     HOW TO GET THERE
                    V                                             SAUSAGE SIZZLE

      P.O BOX 57
                                       CAR PARKING
                                                                  AFTER THE EVENT
      FAX NO: 4645 4681

                                                                  BARREL DRAW PRIZES


                                        When You Arrive
 Event Categories                                  All team entries must be submitted
                                                   together in one envelope by Tuesday
                                                   6th November 2007.                          1st, 2nd & 3rd in each individual age
                                                                                               category will receive a trophy.
EVENTS                                             You can only be a member of one
   There will be a 10k run and a 5k run.           team.                                       In the team categories, winning teams
   Walkers are welcome to participate in                                                       will receive a trophy and the first
                                                   Only school students are eligible to be     four members of the winning team
   both events.
                                                   members of school teams.                    to complete the course will receive an
    Mark one event only on your entry                                                          individual medal.
    form.                                       TEAM CATEGORIES
                                                5K FUN RUN                                   RESULTS
                                                                                               All finisher’s who complete their event
   In the 5k and 10k events there will be          Primary School. Ages 8 to 12 years.
                                                                                               and hand in their time slip after their
   trophies and prizes awarded to the                                                          event for recording will receive a
   outright 1st, 2nd & 3rd for both male        10K FUN RUN.                                   finisher’s certificate and a results
   and female.                                                                                 summary by mail.
   Trophies will also be awarded to                Female.                                     In order to qualify for an age category
   1st, 2nd & 3rd in the following age             Corporate.                                  prize you must put your age on the entry
   categories for both male & female:                                                          form.
                                                NOTE Team entries close on
                                                Tuesday 6th November 2007.
   5K RUN                                                                                    PRIMARY SCHOOL TEAMS
   8 to 9, 10 to 11, 12 to 13, 14 to 15, 16      Prizes                                        A $250.00 cash prize will be awarded
   to 19, 20 to 29, 30 to 39, 40 to 49, 50 to                                                  to the Primary School Team with the
   59, 60 to 69, 70 years and older.            Outright winners and place getters in the      most finishers in the 5km event and
                                                10k & 5k are not eligible for a prize or       who complete their event in less than
   10K RUN                                      trophy in the individual age categories.       90 minutes. Note only finishers who
   15 years & under, 16 to 19, 20 to 29, 30                                                    have completed the team’s section on
   to 39, 40 to 49, 50 to 59, 60 to 69 & 70     10K FUN RUN                                    the entry form can qualify as a team
   years and over.                                                                             member.
                                                   Outright 1st Male & Female $100.00,                  Kindly sponsored by
Walkers are welcome to participate in the          2nd Male & Female $75.00, 3rd Male &
5 &10k event but there is a cut off time of                                                         Campbelltown City Council.
                                                   Female $50.00.
2 hours.
                                                                                             BARREL DRAW PRIZES
TEAMS                                           5K FUN RUN                                     To be entered in the barrel draw you
   Teams may be entered in the categories          Outright 1st Male & Female $75.00,          must hand your timing slip in at the
   listed below. A team can have any               2nd Male & Female $50.00, 3rd Male &        finish area.
   number of members. The combined                 Female $30.00.                              To be awarded a barrel draw prize you
   times of the first four members of the                                                       must be present when the draw takes
   team to cross the finish line will be                                                        place. The presentation will start at
   used to determine the results.                                                              approximately 10.30am followed by
                                                                                               the barrel draw.


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Description: 10k Run, 5k Run and Walk