RELAY TEAM ENTRY FORM 2006
 
TEAM NAME: ..................................................................... 

Team Category (eg FMFM, FM etc.) ............................................... 

Leg Running Order (1234, 3142 etc): ............................................ 
 
Team Members:

1. SURNAME:...................... FIRST NAME:............. DOB:../../... Sex:...
 
2. SURNAME....................... FIRST NAME:............. DOB:../../... Sex:...
 
3. SURNAME:...................... FIRST NAME:............. DOB:../../... Sex:...
 
4. SURNAME:...................... FIRST NAME:............. DOB:../../... Sex:...
 
Name and Address of Team Captain:

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

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

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

Telephone...........................(hm)....................................(wk)
 
Fees:

   Team Entry Fee (see info for explanation)     $68.00 ........ $51.00 ........
   Brindabella Classic Coffee Mug                $ 7.00 ........
   T-Shirt (One design only) XL  L  M  S         $30.00 ........
   Bus seat (Mt Ginini)                          $16.00 ........
   Bus seat (Bulls Head)                         $11.00 ........
   Late entry fee (if posted after 13/10/2006)   $20.00 ........
   TOTAL AMOUNT DUE..............                $..............

Late Entries/Buses: Late entries will be accepted at Race HQ prior 6.15am.
                    Bus departing at 06.15.  Note that Teams are to make their own 
                    transport arrangements to get runners to the relay changeover 
                    points.
 
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
 
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:......................

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

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

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