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2011 ENTRY FORM MCAT, 25 January 2011 |
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First Name |
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Surname |
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Postal Address |
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Phone # |
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DOB |
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Email |
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Rio 2016 Athlete |
Y / N Please circle |
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Club |
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Registration # |
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Signed |
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Date |
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Events entered |
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Seasons Best |
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Grade |
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Relay names |
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Runner1 |
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Runner2 |
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ENTRIES:
Host Club Athletics Wanganui Inc
Entry First Entry $10.00
Additional Events (Each event) $ 5.00 (includes relays)
Entries Close 18 January 2011 (post marked by this date)
NO
LATE ENTRIES ACCEPTED
Should an athlete not be
able to compete for any reason, no refund of entry fee will be payable.
Athletes entering NZM/W 19 3km
Champs should enter via Athletics NZ online entry or postal entry.
Payment Cheques must be made out
to Athletics
Wanganui Inc
No entry will be accepted without payment
Post Post entry form and cheque to
Athletics Wanganui Inc
C/-
25 Godwin Cresent
WANGANUI
Contacts Mike
Dwyer 021 119 0127 miked@infogen.net.nz
Alec McNab 021 421 145 amcnab@collegiate.school.nz