| Post entries to: TE HOUTAEWA CHALLENGE PO Box 403 Kaitaia New Zealand. |
2005 Te Houtaewa Challenge 90 Mile Beach Run
INDIVIDUAL ENTRY FORM
IMPORTANT! Print clearly. Please complete form in BLOCK LETTERS. Use black pen only.
EVENT ENTERED
| ULTRA MARATHON | MARATHON |
| HALF MARATHON-RUN | HALF MARATHON- WALK |
| 6 KM WALK | |
[Please tick one]
| SURNAME: | _____________________________________________________ |
| FIRST NAME: | _____________________________________________________ |
| ADDRESS: | _____________________________________________________ |
| SUBURB: | _____________________________________________________ |
| CITY: | _____________________________________________________ |
| COUNTRY: | _____________________________________________________ |
| TELEPHONE: | _____________________________________________________ |
| OCCUPATION: | _____________________________________________________ |
| ATHLETIC CLUB: | _____________________________________________________ |
MALE / FEMALE |
|
| DATE OF BIRTH: | _____________________________________________________ |
| PREVIOUS BEST TIME: | _____________________________________________________ |
| PREDICTED TIME: | _____________________________________________________ |
| FIRST ATTEMPT AT DISTANCE ENTERED: | _____________________________________________________ |
| FULL EVENTS COMPLETED: | _____________________________________________________ |
Shirt Size (PLEASE ONE ONLY) [ S M L XL XXL XXXL] (tick one)
I agree to comply with the rules, regulations and event instructions of the Te Houtaewa Challenge 90 Mile Beach Run
Signed:_____________________________________________________
Email
: Tall-Tale-Tours@xtra.co.nz
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2003