Ravensbourne Fun Run & Walk

12th November 2011 - 8:30 am start

Ravensbourne Sporting Grounds

Cnr Esk Hampton Rd & National Park Rd

Registration Form

Name: _______________________________________________

Age Division: ____________________    M/F

Division:  6 kms / 3 kms

Contact details:________________________________________________________________

Declaration:   I hereby acknowledge that I am entering the Ravensbourne Fun Run to be held on the 12th November 2011 at my own risk and agree not to bring any damages against any person directly or indirectly associated with the conduct of this event.

Signature: ____________________________________________     Date: ________________

Under 18 Declaration

I ________________________________________  of _________________________________

being the parent of the abovenamed do hereby indemnify all companies or persons to claim in respect whosoever directly from Ravensbourne Sporting Association Fun Run

Signature: ____________________________________________     Date: ________________