Coromandel Classic 2012

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Individual or team leader details

Name

First

Last

Phone


Email


Address

Street Address


Suburb


City

Category
Individual Men Open
Individual Women Open
Individual Men Veteran
Individual Women Veteran
Relay Team 2 People
Relay Team 3 People
Relay Team 4 People
Traverse Team 2 People
Traverse Team 3 People
Traverse Team 4 People

Complete the following if applicable for Relay and Traverse teams.

Team Name


Competitor 2


Email 2


Competitor 3


Email 3


Competitor 4


Email 4


WAIVER In consideration of the acceptance of entry, I / we herby release and discharge the organizers, all sponsors, volunteer groups or individuals from all claims for injury and / or loss I / we may suffer. I / we agree to comply by the rules of the event and by all traffic laws and I / we compete entirely at my / our own risk. I / we also give permission for my / our photo(s) to be used in further and future event promotions with no recompense.