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.