March 29, 2015 11th Annual Run or walk for Charity at Calamvale District Park Formby St, Calamvale Brisbane. MAJOR BENEFICIARY A joint initiative of the Rotary Clubs of Sunnybank Hills and Forest Lake. How To Enter You can register and make secure payment on line at www.rotaryfunrun.org, or complete the entry form on the reverse of this page. For mailed entries please sign the legal declaration and send the form together with your cheque or credit card payment to the Rotary Club of Sunnybank Hills, PO Box 400 Sunnybank Qld 4109. Entries to be postmarked no later than Wednesday 25th March, 2015. Details The Fun Run takes place on Sunday 29th March 2015 at the Calamvale District Park, Formby Street, Calamvale, Brisbane. (Please note new venue. The event was previously held at Nathan Campus, Griffith University.) The start and finish will be at the Formby Street end of the park and will be clearly marked (see map over). The course follows paved walkways through and around the park and will provide enjoyment and challenge for children (12 years and under), the beginner, walker or even more serious competitor (5 Km course). Water stations will be available en-route. There will be a Sausage Sizzle and drinks for sale near the assembly area during and at the completion of the Fun Run. Prizes There will be prizes for entries in 4 categories as shown below. prize for the school team with most entrants. Random Prize draws will also occur during the Fun Run. There will also be a Category Entry Fee 2 Km Run/Walk K $10 A $30 10:00 am Masters Male and Female 5 Km Run/Walk 5 Km Run/Walk $30 10:00 am Junior Male and Female 5 Km Run/Walk B C Schedule Distance 8:30-9:30 am Registration and Late Entry 9:15 am Warm Up 1 9:30 am Childrens Male and Female 9:45 am Warm Up 2 10:00 am Open Male and Female 1. Notes: 2. 3. $10 Family concession (2 A + 2C) $ 70.00 Team Concession – For teams of 6 or more participants registered under a group name - $15 per participant. (School or Little Athletics Club teams at $10 per participant) Race numbers will be handed out on the morning of the race when you are required to check in. Enquiries: For more information phone 0419 026 817 or visit the website www.rotaryfunrun.org Entry Form (Use this form or register and pay online at www.rotaryfunrun.org (Note: one form per individual if using paper form) Name: _________________________________________________ Telephone: _________ Team Name (if part of a team or school with 6 or more entrants): ___________________________________________________ Address: _______________________________________________ Email: ______________________________________ Category (please circle): Gender: Male / Female (Please Circle) A B C K Masters must be 55 years or over as at 29th March, 2015 Juniors must be 15 years or under as at 29th March, 2015 Children must be 12 years or under as at 29th March, 2015 Declaration (1) I the undersigned in consideration of and as a condition of my entry in this event for myself, my heirs, executors and administrators, hereby waive all and any claim, or right or cause of action which I or they might otherwise have for or arising from loss of my life or injury, damage or loss of any description whatsoever which I may suffer or sustain in the course of or consequent upon my entry or participation in this event. (2) This waiver, release and discharge shall be and operate separately in favour of, the Rotary Club of Sunnybank Hills, volunteer and support personnel and so shall operate whether or not the damage or cause is due to any act or neglect of any one or more of them. (3) I permit the free use of my name and picture in the broadcasts and telecast as they pertain to this event. (4) I acknowledge that my entry fee is non-refundable. (5) I declare that I have read the above waiver and release and understand its contents. (6) I attest that I am physically fit and have sufficiently prepared for the completion of the entered race or walk. (7) I agree to abide and be bound by the Rules, as varied from time to time, governing the event. (8) I consent to receive medical treatment, which may be advisable in the event of illness or injury suffered by me during this event. (9) My registration is not transferable to other people if l am unable to compete or if the event is cancelled by way of circumstances beyond the control of directors, my registration fee is non-refundable. (10) The information supplied on this form is true and correct (11) I understand that animals, pets, bicycles, skateboards etc. are not permitted on the course. (12) PRIVACY: The Rotary Clubs of Sunnybank Hills and Forest Lake (the Clubs) collect the personal information requested on this form to enable the efficient operation of the Fun Run that you have entered and to complete the administrative and payment functions associated with that event. By signing the Entry Form, you unconditionally assign to the Clubs all right title and interest you may have in any and all audio and/or photographic recording of you/your Child and grant to the Clubs permission to use, licence and publish or otherwise deal with such audio or photographic recordings including for the purpose of advertisement, promotion or otherwise and further grant permission to publish your / your child’s name and race times and provide contact details to sponsors and the like. You may obtain a copy of your personal information or withdraw consent to use of personal information by contacting the club address below. Signature: _______________________________________________ Declaration of Minors Date:_____/_____/_____ If you are under the age of 18 years on the day of the race, this declaration must be signed by your parent or guardian. (1) I certify that I am the parent or guardian of the minor specified below and that the age specified is true and correct on the day of the event. (2) I certify that he/she has trained for and has my consent to compete in the event. (3) I testify that I have read the above and acknowledge acceptance of the stated conditions on behalf of the minor specified. Minors Name: ______________________________________________________________________ D.O.B. __________________ Parent or Guardian’s Signature: _______________________________________________ Fees: (per runner) Fun Run/Walk Entrance Fees: Adults $30 Child $10 Junior $10 Team $15 Family (2 A + 2C) $70 School or Little Aths. Team $10 Payment: _____Paid by cheque (Please enclose) Or Charge my (tick) _______MasterCard ______Visa Card (American Express Not Accepted) Amount: $_________ Card Number: ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ *CVV/CSC Number: ___ ___ ___ *(The CVV/CSC Number comprises the last 3 digits found on the signature panel on the back of all Visa & MasterCard credit and debit cards and is now required by our card service.) Name on Credit Card: ______________________________________________________________________________________ Signature: ____________________________________________________________________________ Expiry Date: _______ If completing paper entry please mail your entry form with your payment to The Rotary Club of Sunnybank Hills, PO Box 400, Sunnybank QLD 4109. Entries to be postmarked no later than Wednesday 25th March, 2015. Entry fee is non-transferable and non-refundable. Fun Run map available on the day and also on website at www.rotaryfunrun.org Please note that ample car parking is along Benhiam St. All competitors must CHECK IN at venue on the morning of the event to receive their Race Numbers. ® Major Sponsor - Acacia Ridge Community Bank Branch of Bendigo Bank "Proudly Supported by the Lord Mayor’s Suburban Initiative Fund and Councillor for the Parkinson Ward"