Lake Wanaka Half 2010 Individual Entry Form

1. Entry Form > 2. Payment Options > 3. Payment

 

You can enter online and pay securely using your Credit Card or PayPal account.

You must read and agree to the Rules and Regulations and Waiver before you can complete an entry.

Entries close on Friday 11 December 2009. *Indicates required fields.

 

Personal Details

First Name: Required. *
Last Name: Required. *
Gender: Select. *
Are you a professional athlete? Select. *
Date of Birth: (dd/mm/yyyy) Required. *
Age on race day: Required. *
Phone: Required. *
E-mail: Required.Invalid format. *
Street Address: Required. *
City: Required. *
Postal Code: Required. *
Country:
Occupation: Required. *
Nationality: Required. *
Do you speak English? Select. *
If no, what language do you speak?
T-Shirt Size: Select. *

 

Arrival/Departure Date

Wanaka Arrival Date:
Wanaka Departure Date:

 

Estimated Times

Swim (hours/minutes) Required. *
Bike (hours/minutes) Required. *
Run (hours/minutes) Required. *

 

Personal Accomplishments

 

 

Emergency Contact

Next of Kin Name: Required. *
Relationship to you: Required. *
Address: Required. *
Phone: Required. *

 

Medical

Do you have a medical condition?
e.g. asthma, high blood pressure, diabete etc?		 Select. *
If yes, please give details and any treatment or medication required:
Do you have any allergies? Select. *
If yes, please give details and any treatment or medication required:

 

Sponsors Information

From time to time our sponsors may have information that will be of interest to you.
Tick here if you do not want to receive any updates from our sponsors

 

Declaration

Please Tick. I have read and agree with the Rules and Regulations
Please Tick. I have read and agree with the Waiver