North Island Athletic Championships – Entry Form

Palmerston North - 10 December 2016

12.30pm-7.30 pm

(Manawatu Community Athletics Track - Massey University)

Personal Details

First Name:Click here to enter text. / Club:Click here to enter text.
Last Name:Click here to enter text. / Date of Birth: Click here to enter text.
Email:Click here to enter text. / Male:☐Female: ☐
Track Event / Field Event
Tick / Event / Season Best / Personal Best / Tick / Event / Season Best / Personal Best
☐ / 100m / Enter text. / Enter text. / ☐ / Long Jump / Enter text. / Enter text.
☐ / 200m / Enter text. / Enter text. / ☐ / Triple Jump / Enter text. / Enter text.
☐ / 400m / Enter text. / Enter text. / ☐ / High Jump / Enter text. / Enter text.
☐ / 800m / Enter text. / Enter text. / ☐ / Pole Vault / Enter text. / Enter text.
☐ / 1500m / Enter text. / Enter text. / ☐ / Shot / Enter text. / Enter text.
☐ / 5000m / Enter text. / Enter text. / ☐ / Discus / Enter text. / Enter text.
☐ / 100m/H / Enter text. / Enter text. / ☐ / Javelin / Enter text. / Enter text.
☐ / 110m/H / Enter text. / Enter text. / ☐ / Hammer / Enter text. / Enter text.
☐ / 3000m/SC / Enter text. / Enter text. /
☐ / 400m/H / Enter text. / Enter text. /
☐ / 3000mWalk / Enter text. / Enter text. /
☐ / 4x100m / Enter text. / Enter text. /
☐ / 4x400m / Enter text. / Enter text. /

Entries*

*Entries ($20) close 5pm Sun 4 Dec 2016

*Late Entries ($40) close 11am Sat 10 Dec 2016

Meeting enquiries to George McConachy at

Please email all entries toAlan Adamson at

Payment

☐ / Pay direct $20 to PNAHC Bank A/C ANZ 01-0755-0020333-00Reference Details: NIAC & “Name”
☐ / Send Cheque $20 to PNAHC, PO Box 1336, Palmerston North

Programme

12.30 pm Hammer Men, Hammer Women, / 3 50 pm 1500m
12.30 pm 110m H Men / 4 15 pm 400m
12.40 pm 100m H Women / Break
2 00 pm Pole Vault , Triple Jump / 5 15 pm 400mH,
2 10 pm 3000mstch / 5.45 pm 200m,
2 15 pm Discus / 6 00 pmHigh Jump Men
2 30 pm 100m / 6.15 pm 800m
3 10 pm 5000m / 6.30 pm 4x100m
3 15 pm Long Jump Javelin / 6.35 pm3000m Walk
3 30 pm High Jump Women, Shot Put / 7.10pm 4X400m
*Please see the full programme for further details regarding
implements.