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Spectrum Fun Run & Walk

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					                Entry Form                                                                       Events
   SPECTRUM                                                                         SPECTRUM


FUN                                                                               FUN                                            Moreton Bay Regional Council
RUN                                                                               RUN                                                         PRESENTS
       WALK                                                                             WALK
 AND




                                                                                  AND
                          DECLARATION
                                                                                                                                         SPECTRUM


                                                                                                                                    FUN
                                                                                 Moreton Bay Regional Council Event
THE DECLARATION BELOW MUST BE SIGNED FOR VALID ENTRY.                                              8km Run/Walk
DECLARATION: I hereby apply for acceptance of my entry in the
Spectrum Fun Run & Walk (“Fun Run”) and in consideration of                                    Struddy’s Sports 5000   NEW
                                                                                                                         09
your accepting my entry in the Fun Run, I, my heirs, executors and                                 5km Run/Walk        IN 20
administrators, waive all claims, rights or causes of action at law
which I or my heirs, executors or administrators may have arising                              Phil’s Rotary’s Dash




                                                                                                                                    RUN
out of entry participation in the Fun Run. I acknowledge the potential                      2km Run/Walk
risk to myself in participating in the Fun Run, which could result in       All winners and placegetters receive trophies.
my loss of life or permanent injury. I further acknowledge that I will
abide by all aspects of the Fun Run rules as advertised. I hereby         All proceeds assist people with disabilities in our
release and discharge all persons, corporates and bodies involved          community through the Spectrum Organization.
or otherwise engaged in the promotion and staging of the Fun
Run and all other persons, servants and/or agents duly organised


                                                                                         Sponsors
                                                                            SPECTRUM
regardless of the loss, injury or damage which may be attributed to
                                                                          FUN

                                                                                                                                           WALK
any act, omission or neglect by any of the parties. I hereby waive all
propriety rights to all publicity shots of the Fun Run in which I may     RUN




                                                                                                                                     AND
be involved.                                                                    WALK




                                                                          AND
DECLARATION TO BE SIGNED BY PARENT OR GUARDIAN FOR
ENTRANTS UNDER 18 YEARS OF AGE: I certify that as parent/
guardian of the entrant, that he/she trained for the Fun Run and has
my full consent to enter and participate in the Fun Run.
NOTE: Please write “parent/guardian” in brackets after your
                                                                                                                                the fun run and walk for everyone!
signature. If “parent/guardian” is not written after a signature, it is                                                         PROCEEDS ASSIST PEOPLE WITH DISABILITIES
assumed that the entrant is over 18 years of age.                          Ph: 3205 4746                     Ph: 3205 6897
1. Signature: _____________________           Date: _____________                                                                  Sunday June 28

                                                                                                                                           2009
2. Signature: _____________________           Date: _____________         PHIL’S                          All Seasons
3. Signature: _____________________           Date: _____________
                                                                          ROTARY’S                        FRUIT MARKET

4. Signature: _____________________           Date: _____________                                            Ph: 3205 1095
                                                                           Ph: 3205 4433                                            Spectrum Recreation
                                                                                                                                       & Fitness Centre
                            PAYMENT                                                                                             10 Leanne Crescent, Lawnton, QLD 4501
                                    EARLY    ON THE
                          NO.       BIRD      DAY          TOTAL            Strathpine                       Ph: 3205 1235              Event Co-ordinator: Breakout Adventures
                                                                                                                                                   Phone: 3851 2632
Adults                  ______ @   q $15 q $20        =$
                                                                                                                                           www.breakoutadventures.com.au
Concession/Student      ______ @   q $5 q $10         =$                    HOEK
Family                  ______ @   q $30 q $40        =$
                                                                            MODULAR HOMES                                        ENTER ONLINE NOW
                                                                                                                                www.spectrumfunrun.com
(2 adults/3 children)

                                              TOTAL = $                         Ph: XXXXXXX                 Ph: 0412 256 598

            Please make cheques payable to                                                 Ph (07) 3889 8888                    Proudly sponsored by:
             Spectrum Recreation & Fitness                                       www.spectrumfunrun.com
                                                                                                                                                Entry Form
                                                                                                                                     SPECTRUM

      SPECTRUM                       Proudly                                                        ENTRY FEES                    FUN

 FUN
                                   sponsored                  Early bird/online registration closes Thurs, 18 June at 4pm.        RUN
                                                                                                                                         WALK
                                   by Moreton




                                                                                                                                   AND
                                                              All early bird/online registrations enter prize draw for a
                                                                                                                                           YOU CAN ALSO ENTER AND PAY ONLINE
                                  Bay Regional                year’s membership at Spectrum Recreation & Fitness.



 RUN
                                                                                                                                  GO TO: www.spectrumfunrun.com
                                    Council.                                                  Early bird/Online      On the day                                                CATEGORY
                                   Participants can           Adults                                           $15         $20    1. Surname: ____________________________


         WALK
                                 register for either an       Concessions/students                              $5         $10    First Name/s: ______________________________________
   AND




                                  8km, 5km or a 2km
                                                              Family (2 adults/3 children)                     $30         $40
                                       run/walk.                                                                                  Street: ____________________________________________

                 PRE-RACE ENQUIRIES                                                              HOW TO ENTER                     Suburb: __________________      Post Code: _____________

Breakout Adventures                                                                                                               Date of Birth: ______________   Phone : ________________
                                                              Enter online at www.spectrumfunrun.com OR complete
10 Leanne Crescent, Lawnton                     3851 2632     the entry form opposite, sign the declaration and post                                                           CATEGORY
Spectrum Recreation & Fitness                                 with the CORRECT ENTRY FEE TO:
10 Leanne Crescent, Lawnton                     3889 8888                                                                         2. Surname: ____________________________
                                                              (please do not send cash - cheque or money order only)
Struddys Sports Strathpine                                                                                                        First Name/s: ______________________________________
Shop 1, 709-713 Gympie Rd, Lawnton              3205 6897                   Spectrum Recreation & Fitness
                                                                            10 Leanne Crescent                                    Street: ____________________________________________
Your pre-race package must be collected from one of the                     Lawnton 4501
above locations between Monday 22 and Friday 26 June.                                                                             Suburb: __________________      Post Code: _____________
                                                              Or drop in at the reception desk in the gym.                        Date of Birth: ______________   Phone : ________________
                  RACE DAY SCHEDULE
                                                                                                                                                                               CATEGORY
There is limited availability for registrations on the day.                                              COURSES
Registration                               6.45am - 7.45am                                                                        3. Surname: ____________________________
Warm-up and Briefing                                7.50am                                                                        First Name/s: ______________________________________
Start – 8km, 5km                                    8.00am
Start – 2km                                         8.10am                                                                        Street: ____________________________________________
                                                                                                                                  Suburb: __________________      Post Code: _____________
                      CATEGORIES
                                                                The run commences at
                                                                the Spectrum Recreation                                           Date of Birth: ______________   Phone : ________________
                                  2km                5/8km      and Fitness Centre and
                                                                moves along Leanne                                                                                             CATEGORY
                                                                Crescent until the junction
People with disabilities           D2               D5/D8       at Paisley Drive where a
                                                                right turn is taken. Turn left                                    4. Surname: ____________________________
Primary school                    PS2             PS5/PS8       at Lawnton Pocket Road
                                                                and run up to Gympie Road.                                        First Name/s: ______________________________________
High school (under 18)            HS2             HS5/HS8       From Gympie Road turn left
                                                                into Bucky Street and
Open                               O2               O5/O8       another left onto Bells Pocket                                    Street: ____________________________________________
                                                                Road and left again onto
Seniors (50+)                      S2               O5/S8       Lawnton Pocket Road. A loop                                       Suburb: __________________      Post Code: _____________
                                                                of Walker Road is completed
                                                                whilst on Lawnton Pocket
NOTE: Simply add M (male) or F (female) to the end              Road followed by a left turn                                      Date of Birth: ______________   Phone : ________________
                                                                into Paisley Drive and right into
of the code when filling out the categories box on the          Walter Crescent and when exiting
                                                                turn left back into Paisley Drive
entry form. (ie. Primary school male in the 5km would           and right into Lucy Street, right into                            ALL COMPETITORS (OR PARENT/GUARDIAN) MUST
                                                                Leanne Crescent and the finish line
be PS5M).                                                       at Spectrum.                                                      SIGN THE DECLARATION OVERLEAF TO BE ELIGIBLE.

				
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posted:3/13/2010
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Description: Spectrum Fun Run & Walk