| Non-Teams |
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| Entrant
1 : (Please print) |
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| Surname:
.Given
Names:
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AGE on race day
... Sex M/F |
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| Postal
Address:
State:
Postcode:
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Postcode
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| I
am a financial member of
.Canoe Club
..state |
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| Camp
Location: Forshaw's Check 3
Check 2 Mellish Check 1 Start |
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| (Circle) |
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| Landcrew/Emergency
Contact: |
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| Name:
Phone No:
Camp: (If Different)
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| I agree to abide by the clauses listed on this
form:
Signature:
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| Entrant
2 : (Please print) |
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| Surname:
.Given
Names:
...AGE on race day
.Sex M/F |
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| Postal
Address:
State:
Postcode:
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..Postcode
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Postcode
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| Phone No:
..Email
Address:
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| I
am a financial member of
..Canoe Club
State |
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| Camp
Location: Forshaw's Check 3
Check 2 Mellish Check 1 Start |
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| (Circle) |
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| Landcrew/Emergency
Contact: |
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| Name:
Phone No:
Camp: (If Different)
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| I agree to abide by the clauses listed on this
form:
Signature:
. |
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| Background: |
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| Please
provide information on yourself, team, sponsor, landcrew etc. This material
will be used at the finish |
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| line and/or
for publicity puposes: |
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| _______________________________________________________________________________________________ |
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| _______________________________________________________________________________________________ |
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