Teams Corporate and Non-Sponsored

Team Name:                                            Corporate Sponsored

(Please Tick)

_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Non-Sponsored

Team Leader: (Please Print)

Surname:…………………………….Given Names:…………………………………     Age……………  Sex: M/F

Postal Address:…………………………………………………………………State:……………Postcode:……………

Phone No:……………………………………………….Email Address:…………………………………………………..

Camp Location:     Bridge        Foreshaw's          Check 3           Check 2          Mellish           Check 1        Start

(Circle)

Landcrew/Emergency Contact:

Name:………………………………………………Phone No:……………………Camp: (If Different)…………………….

Team Members: (Maximum of 8 per team) Please Print

We agree to abide by the

clauses listed on this form

Surname

Given Names

Address

DOB

Entrants Signature &

Guardian if under 18

1.

Entrant

Guardian

2.

Entrant

Guardian

3.

Entrant

Guardian

4.

Entrant

Guardian

5.

Entrant

Guardian

6.

Entrant

Guardian

7.

Entrant

Guardian

8.

Entrant

Guardian

Clauses-

In consideration of being accepted by the North West Canoe Club as an entrant in the Gregory River Canoe Marathon, I agree:

.

To comply with the rules prescribed by the North West Canoe Club for the conduct of the Gregory River Canoe Marathon.

.

To hold the Club, it's Officials, Servants, Agents and Sponsors harmless against loss or injury of any kind (including fatal injuries)

incurred or suffered by me and arising out of or inconjunction with my participation in the Gregory River Canoe Marathon, whether

or not such a loss or injury shall have been caused by an act, omission or negligence of the Club, it's Officials, Servants, Agents or

Sponsors.

.

To indemnify the Club, it's Officials, Servants, Agents and Sponsors against any claim or demand whatsoever made by any person or

persons arising out of or in connection with participation in the Gregory River Canoe Marathon.