COASTAL WALK AGAINST DOMESTIC & FAMILY VIOLENCE - Sunday 25 November 2018

ONLINE REGISTRATION FORM

Must be filled in by Friday 23 November 2018

Name

Team Name (if applicable)

If you are participating in a team add your team name here

Address

Postcode

Suburb/Town

Best contact phone number

I intend to start from

Tacking Point SLSC - 7.30am bus from Westport Park, 8am start of walk

Flynns Beach - 8.30am bus from Westport Park, 9am start of walk

Town Beach - 9.30am start of walk (no buses available for this starting point)

I will require transport from Westport Park to start of walk

Yes

COMPETITOR AGREEMENT, WAIVER, RELEASE AND ACKNOWLEDGEMENT (click to read)

I have read and accept the Competitor Agreement, Waiver, Release and Acknowledgement

Yes

Date

DECLARATION FOR MINORS (U/18) Permission is granted by Parent or Guardian that have read and accepted the Competitor Agreement, Waiver, Release and Acknowledgment

Yes

Parent or Guardian Name

Phone

Date