Santa Cycle Registration Form

Santa Cycle Registration Form

Resolution Run 5k/10k - Aberdeen

3 April 2016

Registration Form

Title:

First name:

Surname:

Address:
Postcode:

Contact telephone number:

Email:

Date of birth:

How did you hear about this event?

Please select your distance (circle your distance) 5k 10k

Next of Kin First Name

Next of Kin Surname

Relationship to you

Next of Kin Contact Number

Please list any allergies or medication you are taking, if any

By completing this entry form, you are agreeing to the rules of the disclaimer notice.

  • All participants should satisfy themselves that they are fit to take part before entering the event. If you have any doubts, please refer to your GP.
  • The organisers reserve the right to prohibit individuals from taking part.
  • Participants must follow the instructions of the organisers or their appointed agents at all times.
  • Participants must not be under the influence of alcohol or any other substance.
  • If you are under 18, a parent or guardian must give consent for you to take part in this event.
  • Children under 16 must be accompanied at all times by an adult.
  • If participants are taking medication which could cause drowsiness or other side effects, please seek medical advice before completing the entry form.
  • Cancellation policy: No refunds can be given, however named substitutions can be accepted.
  • Stroke Association reserves the right to change the publicised route at any point up to the start of the event.
  • Participants permit the Stroke Association to use any photographs taken during the event for any advertising or editorial purposes, including the worldwide web.

Stroke Association will take all reasonable care to ensure the event is conducted in a safe manner. Liability cannot be accepted for any damage, injury or loss arising from the negligence of participants (whether through failure to observe the rules of the event or otherwise).

I have read and agree to the disclaimer. I will abide by all rules stated and will take full responsibility for my actions on event day.

Sign: Date:

Registration Fee Payment

Deposit per individual: £20(please note this is non-refundable)

I enclose a cheque/postal order for (insert amount)

payable to the ‘Stroke Association’ YES/NO (please delete as appropriate)

Please debit (insert amount)£20.00 from my debit/credit card YES/NO

Card type: VisaMastercard Switch

*please delete as appropriate
Card number:

Security Code:

*last 3 digits on the signature strip

Issue No [Switch only]

Start Date: Expiry Date:

Card Holder’s Name:

* As printed on the card
Signature:

Registered Card Address:
* If different to address given above

Data Protection
The Stroke Association would like to keep you informed about future events and the work we are helping to make possible. Please choose 'Yes' if you are happy for us to contact you.

Yes No

We will sometimes allow other organisations whose aims are in sympathy with our own to contact our supporters. Are you happy for these organisations to contact you?

Yes No

Are you happy for us to send you information about The Stroke Association's work by email?

Yes No

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