ENTRANCE FORM : DUNDEE & DISTRICT SPCA FESTIVE FUN RUN/WALK 2022 -22 December 2022

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First Name *

Surname *

Age *

Gender *

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ID Number *

Address *

Contact Number *

Email *

I declare that I am physically and medically fit to participate in this event and assume all risks of such participation. I participate in the race at my own risk and hereby indemnify the organizers, officials, all helpers, all sponsors, the national and provincial bodies, local authorities and the Dundee & District SPCA, against injuries and any claim whatsoever which may arise as a result of my participation. I am aware that it is compulsory to have a flash light/head lamp to participate. Person signing this entry form as guardian of a minor hereby consent to such minor being bound by the foregoing and further indemnify the organizer and aforementioned parties to the extent, if any, to which such minor is not. *

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Event Entered *

5km Run/Walk - R55

2.5km Run/Walk - R40

Tshirt Size

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Next of Kin ( Full Name , Tel & Relationship) *

I confirm payment will be made to Dundee & District SPCA to the below banking details : Standard Bank Account Name : Dundee & District SPCA Account No.: 0600 678 53 Current Account , Ref : Run & Name *

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