Supported by Diabetes ACT


Part of Canberra’s Classic Cycle Sunday

Sunday October 31, 1999
10.45am start at Anzac Pde, Parkes Way roundabout

2 x 13km loop down P/way

Entries close 27th October
Registration from 8am
at start/finish

 

 


TOUR OF CAPITAL ENTRY FORM

Print this form and mail it to the address below with all your details included.

Please note that the Entry Fee for this event is $12.


Name: .............................................................

Age: ...........

Gender: M / F

Address: ..........................................................

Post Code: .......

School (if applicable): ...........................................................

Team name (if applicable): ...........................................................

Category:

(      ) 15 - 18
(      ) 19 - 25
(      ) 26 - 35
(      ) 36 - 45
(      ) 46 - 55
(      ) 56 +
(      ) Team (2 per team @ 13 km each; indvidual entries required

Declaration:

I, the undersigned, in consideration of and as a condition of entry in the 1999 Tour de Capital, for myself, my heirs, executors and administrators, hereby waive all and any claim, right or cause of action which I might otherwise have arising out of loss of my life or injury, damage or consequent upon my entry or participation in the said event. This waiver, release and discharge shall be and operate separately in favor of all persons, corporations and bodies involved in or otherwise engaged in promoting or staging this event.

I have no medical impairment which may be detrimental to my health and my ability to participate.

Should the event be cancelled for any reason whatsoever, I understand that entry fees will not be refunded and that no liability of any kind will be attached to any person, corporation or body associated with the event.


Signed: ...................................................

Post entry form along with payment ($12) to:

PO Box 3238
Canberra City, 2601

 


Money donated to assist Diabetes ACT Children’s Camps


For further info contact John Armstrong 02 6241 4930 or Emma Wensing 6247 1733
** Late entries will be accepted for $17 on the day

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