Athletics Southland Senior Championships Entry Form

Athletics Southland Senior Championships Entry Form

First name:

Surname :

Postal address:

ANZ Registration No.

ANZ Club:

Date of birth: Sex: M or W

Telephone:

E‐mail:

Competition Grade:

Entries close 10 February 2018 (late fees apply after this date)

Southland Championship Entry Fees

Registered Athlete:

$6.00 first event per day / $2.00 each additional event

Non-Registered Athlete:

$11.00 first event per day / $2.00 each additional event

LATE FEE & ENTRY COST

Registered Athlete:

$8.00 first event per day/ $3.00 each additional event

Non-Registered Athlete:

$12.00 first event per day / $3.00 each additional event

ENTRY FEES

Day 1 - First Event Fee

Additional Event Fees / ___ @ $ ______
Day 2 - First Event Fee
Additional Event Fees / ___ @ $ ______
Total to Pay: $

Bank Account for direct debit: 03 1750 0085175 00 Use your name as reference

Send Postal Entries / Cheques to:

Secretary of the Track and Field Committee

PO Box 115

INVERCARGILL

Please make cheques payable to: Athletics Southland

Send Email Entries to: Lilian Tudor:

COMPETITION GRADES -

MM, SM, MU20, MU18, MW, SW, WU20, WU18

IMPORTANT NOTES

- Late Entry for track events will only be acceptaed if spare lanes are available

- Non-Registered Athletes are not elegible to take titles or trophies reporting times for all events is fifteen (15) minutes prior to the scheduled starting time

- Southland Masters Championship placings in Sprints, DIstance, Throws and Jumps will be determoned on age-graded performances achieved during the Southland Championships

Draft Programme & Event Timetable Day One - Saturday 17th February

Time / Track Events / Tick / X
11:30 a.m. / 100m (Heats) / All Grades
12:00 p.m. / 1500m / All Grades
12:30 p.m. / 80/100/110m Hurdles / All Grades
1:00 p.m. / 100m (Final) / All Grades
1:30 p.m. / 400m / All Grades
2:30 p.m. / 4x100m Relays / All Grades
Time / Field Events
11:00 a.m. / Hammer / All Grades
12:00 p.m. / High Jump / All Grades
12:30 p.m. / Javelin / All Grades
1:30 p.m. / Triple Jump / All Grades
2:00 p.m. / Pole Vault* / All Grades *

*Pole vault may be held on Sunday 25th if weather conditions are unsuitable

Draft Programme & Event Timetable Day One - Sunday 18th February

Time / Track Events
11:00 a.m. / 200m (Heats) / All Grades
11:30 a.m. / 800m / All Grades
12:00 p.m. / 300/400m Hurdles / All Grades
1:00 p.m. / 200m (Final) / All Grades
1:30 p.m. / 5000m / All Grades
2:30 p.m. / 4x400m Relays / All Grades
Time / Field Events
11:00 a.m. / Shot Put / All Grades
12:30 p.m. / Discus / All Grades
1:30 p.m. / Long Jump / All Grades
2:00 p.m. / Pole Vault (alternative) / All Grades

It is possible there may be slight changes to the start times of some events once entries are finalised. All athletes will be advised of changes

Where heats are not required events will be run as straight finals at the finals time

Declaration:

I declare that I am a financial ANZ Competitive member for the 2017 / 2018 season. In the event of an ‘Act of God’ conditions causing cancellation of the event, my total entry fee is not refundable.

I undertake to exercise my duty of care, as is reasonably practicable, to prevent harm, by my actions, to myself, fellow competitors, officials, and members of the general public.

I authorise my name, voice or picture and any information on this entry form to be used without payment to me in any broadcast, telecast promotion, advertising, or in any other way relating to this event, pursuant to the Privacy Act 1993.

Signed: