Sign up to be a Charity Superstar for Team Cure MS (MS Queensland)
Run for charity this year at the 2017 Brisbane Times City2South presented by Westpac. This is an application form for a Team Cure MS (MS Queensland) Charity Superstar place. Your entry as a Charity Superstar is not guaranteed until confirmed by Team Cure MS (MS Queensland). Please do not apply for general entry in the event until you have heard back from Team Cure MS (MS Queensland).
First Name *
Your answer
Surname *
Your answer
Email Address *
Your answer
Date of Birth *
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Mobile Number *
Your answer
Gender *
Street Address Line 1 *
Your answer
Street Address Line 2
Your answer
Suburb *
Your answer
State *
Country *
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Post Code *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Do you have any Medical Conditions? *
If yes, please provide the relevant details
Your answer
Which race would you like to participate in? *
How much do you intend to raise as a Team Cure MS (MS Queensland) Charity Superstar? *
Your answer
Please outline how you will achieve your fundraising target to support Team Cure MS (MS Queensland). *
Your answer
What is your T-shirt size? *
Would you like to join Team Cure MS (MS Queensland)'s social media pages? *
Would you like to hear more about other Fairfax Events? *
I accept the Terms & Conditions of entry *
To proceed, you must acknowledge that you have READ and AGREE to the Terms & Conditions of entry. To view the terms & Conditions, please visit http://city2south.com.au/event-terms-conditions/
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