Name* First Last Address* Street Address Address Line 2 City ZIP / Postal Code Email* Home PhoneWork PhoneMobile PhoneBirth Date* Date Format: DD slash MM slash YYYY Age (as at 31st December 2017)*Gender*MaleFemaleEmergency Contact Name*Emergency Contact Phone*Consent for Photo Use I consent for photos of me at WHC events to be published on the club website and social media pages, or to be used for WHC marketing purposes. I confirm that I am a member of the Wanganui Harrier Club and I know that running, walking, and volunteering for organized races and social events, with this club are potentially hazardous activities, which could cause injury or death. I will not participate in any club organised events, group training runs or social events, unless I am medically able and properly trained. I understand that WHC will endeavor to undertake all health and safety precautions deemed necessary to make club events as safe as possible. I agree to be present for pre -event safety briefings; and understand that failure to do so may result in me being refused the right to participate. I understand that WHC activities will be held on both public and private land including (but not limited to) farmland, parks, footpaths, and open roads. I assume all risks associated of being a member of this club and participating in club activities which may include: falls, contact with other participants, the effects of the weather, traffic, and the conditions of the road, footpaths, and private and public land. I understand that personal music players are not allowed to be used in club organized activities and I agree to abide by this rule. I agree to abide by all rules established by the club and understand that failure to comply with safety guidelines mayresult in disqualification or suspension. 2017-2018 Grades and Fees Schedule*Family $220Veteran Runner $80Senior Runner $80Veteran Walker $80 (Short Course/ Long Course)Senior Walker $80 (Short Course/ Long Course)Under 20 $65Under 18 $65Under 16 $55Under 14 $35Under 12 $35Under 9 $35Adult Singlets Price: $ 30.00 Quantity: Adult T-Shirts Price: $ 35.00 Quantity: Junior Singlets Price: $ 10.00 Quantity: All athletes will automatically be registered with Athletics New Zealand at no additional charge - please select:*Competitive Athlete (if you wish to compete in any inter-club events/ championships i.e. Dorne Cup, AMW Centre Champs)Social Athlete (if you only participate in Wanganui Harrier Club events)Additional Family Member Adult Name First Last Additional Family Member Adult Birth Date Date Format: DD slash MM slash YYYY Additional Family Member Adult Age (as at 31st December 2017)Additional Family Member Adult GenderMaleFemaleAdditional Family Child Name 1 First Last Additional Family Member Child 1 Birth Date Date Format: DD slash MM slash YYYY Additional Family Member Child 1 Age (as at 31st December 2017)Additional Family Member Child 1 GenderMaleFemaleAdditional Family Child Name 2 First Last Additional Family Member Child 2 Birth Date Date Format: DD slash MM slash YYYY Additional Family Member Child 2 Age (as at 31st December 2017)Additional Family Member Child 2 GenderMaleFemaleAdditional Family Child Name 3 First Last Additional Family Member Child 3 Birth Date Date Format: DD slash MM slash YYYY Additional Family Member Child 3 Age (as at 31st December 2017)Additional Family Member Child 3 GenderMaleFemaleAdditional Family Child Name 4 First Last Additional Family Member Child 4 Birth Date Date Format: DD slash MM slash YYYY Additional Family Member Child 4 Age (as at 31st December 2017)Additional Family Member Child 4 GenderMaleFemaleAmount to pay: (Club fees are payable by 30 April 2017) $ 0.00 Payments can be made via internet banking (please use name as reference) Wanganui Harrier Club 11-6840-0683200-11
