Pre-Registration Form

PRE-REGISTRATION FORM

Sunday 27th August 2017

PARTICIPANT INFORMATION
Last name: / First Name: / q Miss q Mrs. q Mr q Ms
Sex: q M q F / Birth date: / / / Age:
Occupation:
Email Address:
Phone Number:
Street Address:
City: / State: / Country:
Have you ever been a Groundrush Member Before: q Y q N
If Yes, when:
Previous Membership Number:
Bungy Timeslot – Indicate 1st, 2nd and 3rd preferences / q 10am – 12pm
q 12pm – 2pm
q 2pm- 4pm
q 4pm – 6pm
q 6pm – 8pm
*please arrive 30mins prior to your timeslot to sign waiver form and complete weigh in process
Swing Timeslot – Indicate 1st, 2nd and 3rd preferences / q 10am – 12pm
q 12pm – 2pm
q 2pm- 4pm
q 4pm – 6pm
*please arrive 30mins prior to your timeslot to sign waiver form and complete weigh in process
PAYMENT INFORMATION
Bungy Jump Pack / Includes:
1 x Bungy Jump and e-certificate / $99pp q Y
Minjin Swing Pack / Includes:
1x Minjin Swing and e-certificate / $79pp q Y
Locals Annual Groundrush Membership / Includes:
1x Activity (Bungy OR Swing), 1x Annual Groundrush Membership and e-certificate / $99pp q Y
Total payment needed / $______
Credit Card Details: / q VISA q MASTERCARD *please note 1.5% surcharge applies
Name on Card:
Credit Card Number:
Expiry Date: / CSV:
Signature:

Important Information:

·  Cancellations: More than 72hours prior to 27/08/2017 FULL REFUND. Less than 72hours prior to 27/08/2017 NO REFUND.

·  We will contact you with confirmed Bungy / Swing timeslot via email. Please make sure your email address is legible on this form.

·  On the day, please arrive at least 30minutes prior to your Bungy Jump/Minjin Swing time to sign Adventure Activity Waiver form complete weigh in

·  All pre-registrations need to be prepaid. If you don’t wish to pay by credit card (save 1.5% surcharge) please come and visit us onsite to pay with cash / debit card.

·  BUNGY: Must be over 45kgs to Jump Solo. If you do not weigh +45kgs you will have to go tandem with a friend or family member. Crew will be unavailable for tandems on the day

·  BUNGY: Anyone aged 10 - 18 MUST have a parent / guardian with them on the day to co-sign their Adventure Activities Waiver Form.

·  SWING: Min solo weight 55kg. Max weight pp 150kg. Max combined weight 240kg (2 or 3 persons). No age limits apply.

·  Photos and Videos available to purchase on the day. Our innovative Photo and Video system is designed to capture high speed adventure activities in a way never before seen and provide you with a fully edited video in your inbox within 30 minutes of your activity.

Please return this form to or drop in person to AJ Hackett Cairns
Preregistrations close 6pm 24th August 2017
THANKYOU FOR YOUR PRE-REGISTRATION & HELPING US CELEBRATE 27 YEARS IN CAIRNS!!