Jungle Marathon - Entry Form

Page 1

Jungle Marathon Registration Form Part One- Declaration I, the undersigned State that I have read the rules and regulations and terms and conditions of the Jungle Marathon , and that I accept these without reservation. I declare that I am willing to participate in the Jungle Marathon race, in the full knowledge and understanding of the risks that the Jungle Marathon may present. For my registration, I agree to pay the initial deposit of ÂŁ600 on registration, followed by two equal pay ments of ÂŁ500 on the 30th March and the 30th June. I understand that my entry fee is non-refundable but may be tranferred to a future year. I also agree to send a medical certificate and ECG (Electrocardiogram) both dated the month before the start of the race. I will also bring the original to the administrative checks before the start of the race. I certify, under penalty of perjury, that the information given in this registration form and the personal information are correct.

Signed

Part Two - Personal Info

Dated

Part Three - Emergency Contacts

Surname

Person to be contacted in an emergency

First Name

Name

Address

First Name Address

Post code Country Telephone number home Telephone Telephone number work E mail Nationality

Telephone number mobile

Profession Date of birth Passport number ADDITIONAL INFORMATION Are you part of a team, if so please give details

What running experience do you have?

Please Attach 4 x recent passport style photographs here


Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.