Entry Form 2017 Your DetailsName* First Last Date of Birth* Gender*MaleFemaleAddress* Street Address Address Line 2 City AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Phone*Emergency Contact Name* First Last Emergency Contact Phone*Entry DetailsEntry Type*RunWalkSelect Event Type*Marathon Run / Walk - $50.001/2 Marathon Run / Walk - $40.0010km Run / Walk - $25.005km Fun Run / Walk - $15.00Corporate Relay Run / Walk - $60.00Kids 1.2km Fun-Run-Athon $5.00SchoolEstimated TimeTeam Name*Team Member 1* First Last Team Member 2* First Last Team Member 3* First Last Team Member 4* First Last T-Shirt ($45.00)NoneMens SMens MMens LMens XLMens 2XLMens 3XLMens 5XLWomens 4Womens 6Womens 8Womens 10Womens 12Womens 14Womens 16Womens 18Womens 20To Bank and Account: Wanganui Harrier ClubANZ 11-6840-0683200-11 Enter the following details as a reference please: The entrant's Surname followed by Initials and '3BM' (if fits) or, if entering the Corporate Relay, the Team Name and '3BM'.Declaration, Disclaimer and Terms & Conditions*1. I acknowledge that I compete at my own risk. 2. I authorise any information given on this enrty form to be used for promotional and/or results purposes pursuant to the privacy act 1993. 3. I agree to abide by the instructions of race officials, NZ Police and St Johns Ambulance Staff. 4. If a walker is judged to be other than walking, they will be classed as a runner. 5. The understand that the course is partially run on public roads and is open to vehicular traffic. 6. Competitors / entrants must be no more than two abreast at any time. 7. Marathon and Half Marathon competitors / entrants are to be 16 years of age and over. 8. 10km competitors / entrants to be 12 years of age or older. 9. 1.2km Fun-Run-Athon competitors/entrants must be 13 years of age or under. 10. Participants under 7 years of age must be accompanied by a parent or caregiver. 11. No changing of event once started. I agree to and acknowledge the terms listed above. Total $ 0.00 Payment Method*Credit Card / PayPalBank Deposit This iframe contains the logic required to handle Ajax powered Gravity Forms.