Synergy Gallipoli Run. Sunday 19 April 2009. Synergy Parkland, Kings Park. Starts 9am. Run or walk to commemorate the ANZAC spirit. The Synergy Gallipoli Run is a special event held annually in recognition of the ANZAC spirit. Held on Sunday 19 April at Synergy Parkland, Kings Park, this event caters to both runners and walkers alike with three options available – an 8km (5 mile) run, a 4km run or a 4km walk. Take part and also improve your health and fitness as we raise money for Athletics WA and the RSL. To enter, please complete and return the entry form overleaf, or enter online at synergy.net.au/gallipoli Entry form Complete and return to Athletics WA or enter online at www.waathletics.org.au Event entered: 8km run 4km run 4km walk Last Name First Name Gender Age Address Suburb State Postcode Phone Email • Competition bib numbers to be collected at check in from 7.30 to 8.30am. • Bag storage area provided near start area, but leave at your own risk. Entry fees (non refundable) Entry fees are tax deductible. Receipts will be posted on request. By 16 April On the day Adult $15 $20 Concession (under 18, 65+, student) $10 $15 Family (2 adults & 2 concessions) $40 n/a (Family entries must be entered together and the entry fee paid with a single payment.) Entry fee Donation Total Paying by: Cheque Money Order Credit Card* Please post me a receipt Make cheque/money order payable to Athletics WA and mail to: Athletics WA, PO Box 157, Floreat Forum, WA, 6014. Or deliver in person to: Athletics WA Office, Perry Lakes Stadium. *If paying by credit card please visit www.waathletics.org.au Waiver (If you are 17 or under this part must be signed by your Parent or Guardian.) I certify that I am the Parent/Guardian of who is years of age and that he/she has my consent to run in this event, and I hereby join the indemnity below: Signature (Entrant/Parent/Guardian) Date 1. I have read the conditions of entry for this event and understand the demanding physical nature of the event. I have trained for this event and I am not aware of any medical condition or impairment that will be detrimental to my health if I participate in this event. In the event that I become aware of any medical or impairment, or am otherwise sick or injured prior to the event, I will withdraw from the event. 2. I acknowledge that participating in this event may involve a real risk of serious injury or even death from various causes including; over exertion, dehydration, and accidents with other participants, spectators or road users. 3. I acknowledge that it is a condition of participating in this event that I do so at my own risk. I accept all risks and release the event organiser, its agents, affiliates, employees, members, sponsors, promoters, volunteers, and any person or body, directly or indirectly associated with the event, from all claims, demands and proceedings arising out of or connected with my participation in this event and I indemnify them against all liability for all injury, loss or damage arising out of or connected with my participation in this event. This release continues forever and binds my heirs, successors, executors, personal representatives and assigns. 4. I consent to the publication and/or use in any form of media whatsoever of my name, image, voice, statements or otherwise, before, during or after the Event whether for advertising, promotion or otherwise, without payment or compensation. 5. I agree that should the Event be cancelled for any reason whatsoever, my entry fees will not be refunded and no liability of any kind whatsoever will attach to the Organisers. I do not wish to receive athletics related information from Athletics WA.
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"Gallipoli Run registration form for 2009"Please download to view full document