Post entries to:
TE HOUTAEWA CHALLENGE
PO Box 4038
Kaitaia
New Zealand.

2005 Te Houtaewa Challenge 90 Mile Beach Run

RELAY ENTRY FORM

IMPORTANT! Print clearly. Please complete form in BLOCK LETTERS. Use black pen only.

TEAM NAME:

_____________________________________________________

CAPTAIN'S FIRST NAME:

_____________________________________________________

ADDRESS:

_____________________________________________________

SUBURB:

_____________________________________________________

CITY:

_____________________________________________________

COUNTRY:

_____________________________________________________

TELEPHONE:

_____________________________________________________

RUNNER 1

SURNAME:

_____________________________________________________

FIRST NAME:

_____________________________________________________

RUNNER 2

SURNAME:

_____________________________________________________

FIRST NAME:

_____________________________________________________

RUNNER 3

SURNAME:

_____________________________________________________

FIRST NAME:

_____________________________________________________

RUNNER 4

SURNAME:

_____________________________________________________

FIRST NAME:

_____________________________________________________

RUNNER 5

SURNAME:

_____________________________________________________

FIRST NAME:

_____________________________________________________

If ordering t-shirts please enter number required
T shirt sizes required s / m / l / xl / xxl
Number of each size _______________

Members of Relay team can purchase t-shirts at a cost of $25 for each runner with a total of 5 per team.
Note order must be completed and in with entry form at least 4 weeks before the event so as to guarantee sizes.

The team 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
Website: www.Tall-Tale.co.nz
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