Entry Form

General enquiries should be made to –: Bob Cunninghame, Ph (03) 473 8330 or email: signalhill@xtra.co.nz
Entry enquiries, after entries open in early October, to –: Emma de Lacey, Ph. (03) 420 1846 or email: nzra.entries@gmail.com

Entries close 5pm Saturday 10th November. (Late entries until 5pm Saturday 17th November at organiser’s discretion)

Entry Fees: 24 hr - $90 per person (U23 - $45), 7 hr - $45 per person (U23 - $20)
Transport: $50

All information requested below must be completed.

Team Contact:
	Firstname:	Lastname:
	Street:		Town:	Postcode:
	Email:		Phone:	Entry fee:
				Transport:
Team Member 2:
	Firstname:	Lastname:
	Street:		Town:	Postcode:
	Email:		Phone:	Entry fee:
				Transport:
Team Member 3:
	Firstname:	Lastname:
	Street:		Town:	Postcode:
	Email:		Phone:	Entry fee:
				Transport:
Team Member 4:
	Firstname:	Lastname:
	Street:		Town:	Postcode:
	Email:		Phone:	Entry fee:
				Transport:
Team Member 5:
	Firstname:	Lastname:
	Street:		Town:	Postcode:
	Email:		Phone:	Entry fee:
				Transport:

Team Category: (all team members must comply)
Gender:	Men	Women	miXed
Age Group:	U23	Open	Vet (40+)	SuperVet (55+)

Which event?	(Please - no switching between events after you have entered)
	24 hr	7 hr

Total Fees for above selections:
	Entry Fees: $	Transport: $	Overall Total: $

Select method of payment:

Direct credit to NZRA Account No. 03 0674 0197735 00. Please use the Team Contact's name as reference to identify your payment and pay promptly after you have completed this entry.

Cheque payable to New Zealand Rogaining Association. Send to

Moonlight on Mahinerangi Rogaine
c/o Emma de Lacey
108/4 Holmes Rd
R.D. 2
Tai Tapu 7672

Confirmation of entry: Your entry will be confirmed, after payment has been received, by posting it in the list of entrants on the NZRA website.

If you have any message for the organisers please type it here:

Note:

Each competitor must be a member of a Rogaining Association or an Orienteering Club, or must become a member of the NZ Rogaining Association (free), and hereby agrees to abide by the NZRA rules and Code of Conduct. These can be found at http://www.rogaine.org.nz/ where information and online membership are available. Your attention is drawn particularly to the condition of membership that you enter all events entirely at your own risk. All participants will be required to sign an indemnity that neither the Association, the organisers, nor the landowners will be held responsible for any accident or injury which may occur.

(tick)

I (the Team Contact) undertake to ensure all team members have seen or been fully advised of the written event briefing information distributed to me and available at http://www.rogaine.org.nz/ before the event.

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