Ranui Farm Park

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Scenic Farm Running Race entry form

Name: *

Gender: *

Age: *

Home address: *

Phone (please add area code): *

Email address: *

Race to enter: *

1 Loop - $10.00

2 Loop - $15.00

3 Loop - $20.00

IMPORTANT Make cheque payable to Ranui Farm Park and post to 639 Nicholls Road RD2 Waipukurau 4282. Must be received before Race Day. Confirmation of acceptance of your entry will be made by email.

Payment method: *

Direct Credit

Cheque

Indemnity / Declaration - Read and accept or decline the conditions below.: *

decline

The members listed by name above all agree to abide by and comply with the rules, regulations and instructions of this event as given by the organisers and landowners and accept their decisions as final and binding.
We attest that we are sufficiently fit to participate in this event and we are aware of the risks involved and collectively hereby exempt the organisers and other event participants from any liability for damage or injury that may occur to ourselves or our property. Submission of this form constitutes acceptance of all of the aforegoing.

Ranui Farm Park gratefully acknowledges support from the following sponsors:

Scallywaggs Kindergarten & Care	Riddifords Sportsworld	Bike ‘n’ Mow Ltd
9 Russell Street, Waipukurau. 06 8587404 www.scallywaggs.co.nz	81 Ruataniwha Street, Waipukurau. 06 8589142 sports.world@xtra.co.nz	57 Ruataniwha Street, Waipawa. 06 8578442 bikenmow@clear.net.nz