INDIVIDUAL ENTRY FORM 2006

SURNAME:...........................FIRST NAME:..................................

Address:........................................................................

.......................................................Postcode:................

Telephone...........................(hm)....................................(wk)

Sex (M or F).........Date of Birth(DoB)..../..../..........Age on run...........

Email address:..................................................................

Please circle the years you completed the individual run:

              87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

Fees:
                                                Brindabella Classic  Bulls Head Challenge
   Individual Entry                              $65.00 ........        $45.00 ........
   ACTCCC Member                                 $55.00 ........        $35.00 ........
   Brindabella Classic Coffee Mug                $ 7.00 ........        $ 7.00 ........
   T-Shirt (One design only) XL  L  M  S         $30.00 ........        $30.00 ........
   Bus seat:                                     $16.00 ........        $11.00 ........
   Late entry fee (if posted after 13/10/2006)   $20.00 ........        $20.00 ........
   TOTAL AMOUNT DUE..............                $..............        $      ........

Late Entries:  Late entries will be accepted at race headquarters prior 6.15am
               Late fee applies.

Payable to:    Cheques and Money Orders payable to ACT Cross Country Club Inc.

     Payment by Bankcard,  Mastercard,  or Visa  (please circle which card type).
     Please complete the following details:

CARD NUMBER ........ - ........ - ........ - ........        EXPIRES .... / ....

CARD HOLDERS NAME ..............................................................

CARD HOLDERS SIGNATURE .........................................................

Forward to:    Race Director
               Brindabella Classic
               GPO Box 252
               CANBERRA ACT 2601

Entries Close: 13 October 2006

Individuals who complete six BC races are awarded a pottery BC Carafe, completion
of 10 races earns a pottery BC Plate and completion of 15 races earns a pottery
BC Wine Bottle Cooler.  These are awards and are not for sale.

DECLARATION:
1.       I, the undersigned, in consideration of and as a condition of my entry 
in this event for myself, my heirs, executors and administrators, hereby waive 
all and any claim, right or cause of action which I or they might otherwise have 
for or arising out of the loss of my life or injury, damage or loss of any 
description whatsoever and howsoever caused which I may suffer or sustain in the 
course of or consequent upon my entry or participation in this event.

2.       This waiver release or discharge shall be and operate in favour of, the 
ACT Cross Country Club Inc., any other organising club or clubs, all officers, 
members and employees of the Australian Federal Police and all race sponsors and 
shall so operate whether the damage or cause is due to any act or neglect of any 
of them.

3.       I agree to personal details such as name, age, sex and performance being 
shown in published results.


Signed:..............................                Date:......................