2009 Official Entry Form - The Noosa Journal Breakfast Fun Run

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2009 Official Entry Form - The Noosa Journal Breakfast Fun Run Powered By Docstoc
					 The 2009 Noosa Journal Breakfast Fun Run is a great way for runners from beginners
 to champions to enjoy a fun and friendly run to kick off the weekend. The Zonta Club of
 Noosa (Inc.) will donate all proceeds from The Noosa Journal Breakfast Fun Run to the
 National Breast Cancer Foundation for research into breast cancer. This event will also
 feature on Seven SUNRISE on the morning of the event.
Date                            Friday 30th October 2009

Location                        Festival Village, The Woods, Hastings Street, Noosa Heads

Course                          A scenic fun run around the beautiful bays and beaches of
                                Noosa approx. 5km

Prizes                          Everyone who enters has a chance to win great random draw                                                                   How to Enter                      Complete entry form with
                                prizes as well as special prizes for:                                                                                                                         payment to Mail: USM EVENTS
                                                                                                                                                                                              PO Box 1345, Noosa Heads Q 4567
                                Biggest School Team                                                                                                                                           Online: www.usmevents.com.au
                                Win $500 cash courtesy of Richardson & Wrench Noosa

                                Most Innovative Team                                                                                                        Entries Close                     5pm 28th October 2009
                                Prize courtesy of Bluewater Restaurant at Sunshine                                                                                                            Race day entries between 6.30-7.15am
                                Beach Surf Club                                                                                                                                               A late entry fee applies

                                Best Decorated Male Outfit (bra or t-shirt)                                                                                  Entry Fee                         Juniors (under 16) $12.00
                                Prize courtesy of River2Sea                                                                                                 (GST inc)                         Adults $25.00
                                                                                                                                                                                              All proceeds go to the National Breast Cancer Foundation.
                                Best Decorated Female Outfit (bra or t-shirt)                                                                                                                  Includes a huge breakfast and lots of great random prize draws.
                                Prize from The Noosa Spa of Health and Beauty
                                                                                                                                                            Race Day Entries                  Juniors (under 16) $20.00
                                First Male Across the Line                                                                                                  (GST inc)                         Adults $35.00
                                Gift pack from Noosa Heads Surf Club
                                                                                                                                                            Cancellation                      The event organisers reserve the right to cancel,
                                First Female Across the Line
                                Gift from Smyths Hairdressing                                                                                                                                 postpone or relocate the event due to any conditions
                                                                                                                                                                                              deemed unsafe or unsuitable for the conduct of the event.
Race Day                        6.00 – 9.00am SEAFM Live Outside Broadcast
Timetable                       6.30 – 7.15am Check In and Race Day Entries                                                                                 Cancellation Fee                  50% of your entry fee until 5pm 19th October 2009 and NO
                                       (Race day entries accepted until 7.15am)                                                                                                               REFUND after 5pm 19th October 2009.
                                7.30am Run Start
                                7:45am Breakfast Starts                                                                                                     Withdrawals                       Must be in writing by mail, USM EVENTS PO Box 1345 Noosa
                                8.30am Random Draw Prizes                                                                                                                                     Heads QLD 4567 or email info@usmevents.com.au
                                                                                                                                                                                              All entries are non-transferable
Dedicate the event to someone special
                                                                                                                                                            Enquiries                         USM Events on 07 5449 0711 or email info@usmevents.com.au
You can wear a tribute placard or survivor placard to dedicate your participation to
someone you have lost to breast cancer, to someone who is fighting the disease,                                                                              Tax Invoice                       Crossport Management & Marketing Pty Ltd T/A USM EVENTS.
or to someone who has survived breast cancer. Tick the ‘tribute placecard’ or                                                                                                                 ABN# 670 523 42239
‘survivor placard’ below.                                                                                                                                                                     If tax invoice is required, copy entry form before sending.

2009 Official Entry Form -                                                                                                 The Noosa Journal Breakfast Fun Run

TERMS AND CONDITIONS                                                                                                      PARTICIPANTS DETAILS                                 May be photocopied
The following are the terms and conditions of entry of USM EVENTS. These terms are not negotiable and buy
accepting an entry to the event via the USM EVENTS registration system and paying the entry fees you are                  SURNAME                                                                            FIRST NAME
hereby acknowledging your acceptance of our terms and conditions (For competitors under 18, a parent or
guardian must accept) WARNING: This is a legal document that affects your rights, if you are uncertain or                 TRIBUTE PLACARD REQUIRED                                                 SURVIVOR PLACARD REQUIRED
uncomfortable with some of the condition of registration then we recommend that you obtain advice to ensure
you understand and accept the conditions of entry. I agree to participate in this event on the following basis: 1.
I acknowledge that competitive sporting events involve the real risk of serious injury or even death from various         DATE OF BIRTH                                                            AGE AT EVENT DAY                                          MALE             FEMALE
causes including overexertion, equipment failure, dehydration, accidents with other competitors, spectators or
road users, and course or weather conditions and other causes. 2. I understand that I should not participate in
this event unless I have trained appropriately and will be in a fit state to complete the event safely. I
acknowledge that if I am aware of an existing medical condition and uncertain of my state of fitness then a
medical practitioner should verify my physical condition. 3. By participating, I accept all risks necessarily             SUBURB/TOWN                                                                                       STATE
flowing from my participation that could result in injury, loss of life or permanent injury. Accordingly, I release all
persons or corporations associated directly or indirectly with the conduct of the event from all claims demands
and proceedings arising out of my participation and I hereby indemnify them against, all liability (including             PHONE                                                                        EMAIL
liability for their negligence and negligence of others) for all injury, loss or damage arising out of or connected
with my participation in this event. This release shall extend to and include USM EVENTS, Triathlon Australia
Inc, its members, state and territory triathlon associations, Queensland Events Corporation, Sunshine Coast               TEAM NAME (If member)                                                               TEAM CAPTAIN NAME
Regional Council, event sponsors, event marshals and their respective directors, partners, managers, officers,
agents, contractors, employees and volunteers including event medical and paramedical personnel. This
release and indemnity continues forever and binds my heirs, executors, personal representatives and assigns.              OCCUPATION*                                                                           EMPLOYER*
4. I consent to receiving any medical treatment including ambulance transportation that event organisers think
desirable during or after the event. 5. I have provided or attached to my entry form details of any medical or            *Please assist our product development and customer service by supplying all of the information. Information supplied is strictly confidential and for internal use only.
physical conditions from which I suffer that might affect my performance or be relevant if medical treatment is
needed. I accept the risk of participating despite these conditions. I have supplied an emergency contact                 SCHOOL/CLUB                                                                                                 HOUSE
name and number, this person is contactable both during and after the event and is not another participant. 6.
I understand that compulsory insurance cover affected for participants in this event may not cover me for all             EVENT DAY
injury, loss or damage sustained by me. 7. Safety precautions undertaken by organisers (such as course                                            NAME                                                                             PHONE
supervision, race safety briefings, bicycle and helmet safety checks) are a service to me and other participants
but are not a guarantee of safety. 8. My registration is not transferable to other people. Any attempt to transfer         THIS MUST BE COMPLETED: This person must be contactable on this number and can not be another competitor
my entry or allow another person to participate under my name without the event organisers knowledge may
result in total cancellation without refund, insurance being deemed void and inability to enter further USM
EVENTS events. 9. My event registration is 50% refundable up to 5pm 10 days prior to event date. If I am                    SIGNATURE
unable to compete after this time and date my registration fee is non-refundable. 10. Event organisers may
                                                                                                                             THIS MUST BE SIGNED
change the event format, course or other race conditions at their discretion. If that occurs, this agreement
applies to the changed conditions. 11. I agree that if the event is cancelled due to storm, rain, inclement                  Please read the terms and conditions and sign as a condition of entry. Parent/guardian to sign for child under 18
weather, winds or other ‘Act of God’ conditions or safety concerns, or if I do not participate in the event for any
other reason, my entry fee shall be non refundable. 12. I agree to abide by all race results and directions issued
by the event organiser and/or the relevant sport’s governing body. 13. I certify I will receive a race briefing at
registration that I will read and abide by! 14. I acknowledge and consent to photographs and electronic images
                                                                                                                          PAYMENT DETAILS
being taken of me before, during or after the event by an official representative of the event organiser. I                     CASH              CHEQUE                 MONEY ORDER (Cheques and money orders made payable to USM Events)
acknowledge and agree that such photographs and electronic images are owned by the event organiser and
that the event organiser and event sponsors may use the images, my name and my performance for
promotional broadcasting, reporting purposes and/or other purposes at any time by any form of media without                      VISA              MASTER CARD                        AMEX (4% Surcharge applies)
my further consent being necessary. The event organiser is not responsible for photographs and electronic
images taken by persons who are not an official representative of the event organiser. 15. I acknowledge and              CARD NUMBER                                                                                                 EXPIRY DATE
consent to the event organisers providing my personal details (limited to race number and full name) to
Sporting Images for the purpose of promoting photographs from the event. Sporting Images will place photos                                                                                                                                                      MONTH          YEAR
from the event on their website, www.sportingimages.com.au which will be available for purchase. 16. I agree
to my name and contact details being included on the event database which may be used for commercial                      CARD HOLDERS NAME
purposes. I acknowledge that USM EVENTS will automatically subscribe me to the bi-monthly USM EVENTS
email newsletter, which contains important information and updates relating to events. I can opt-out at any
time by clicking the relevant link in any issue of the USM eNews. 17. I am fully responsible for the security of          CARD HOLDERS SIGNATURE
my personal possessions at the event. 18. I acknowledge that I will receive a race timing band at all timed
events which remains the property of USM EVENTS. Should I not return my timing band to USM EVENTS I
agree to reimburse them $50. 19. I certify that I am 18 years of age or older, or I am the parent/legal guardian
                                                                                                                          DONATION TO NATIONAL
of a child under the age of 18 and I have read this document and understand and accept the terms and                      BREAST CANCER FOUNDATION                              $                                         (If using a credit card with secure code, you are not
conditions it contains.
                                                                                                                                                                                                                          permitted to use this method of entry. Please
                                                                                                                          TOTAL AMOUNT                    $                                             (inc. GST)        visit www.usmevents.com.au to enter online)

MEDICAL                                                                                                                                                                                                                           If you do not wish your contact details
                                                                                                                          SEND TO: USM Events, PO Box 1345, Noosa Heads Q 4567
                                                                                                                                                                                                                                  to be included on further USM Events
(see item 5)                                                                                                              PLEASE NOTE: ENTRIES        BY FAX OR PHONE WILL NOT BE ACCEPTED                                        mail outs, please tick.

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Description: 2009 Official Entry Form - The Noosa Journal Breakfast Fun Run