THE 2015 FIRST LADY’S HALF MARATHON
REGISTRATION FORM
8TH OF MARCH 2015, NYAYO STADIUM
PERSONAL DETAILS
First Names
Last Name
,
Date of Birth
Nationality
Gender
Da Mo Yr
County of Residence
M/F
Phone No.
Email
ID/Passport No.
RACE CATEGORY (PLEASE TICK ONE)
Distance:
2km
10km
Wheel Chair/ Tricycle (21km)
21km
Elite:
YES
NO
WHAT IS YOUR PERSONAL BEST TIME?
10km Race
21km Race
Under 40mins:
40mins - 1hr:
Over 1hr:
Under 1hr 10mins:
1hr 10mins - 1hr 40mins:
Over 1hr 40mins:
KSH 1,500
PER PARTICIPANT
T-SHIRT SIZE
XS
S
M
L
XL
XXL
NEXT OF KIN
Relationship
Phone No.
DECLARATION
I have read and understood the rules and regulations and agree to participate on the understanding that I will adhere to all
the rules and regulations of the event entered. Waiver Clause: In consideration of the acceptance of my entry, I, my heirs,
successors, and assigns, do hereby unconditionally waive and release the organisers, this competitions sponsors and all
persons and agencies connected with it, from all claims and damages whatsoever, that may arise from my participation in
this competition, including without limitation, personal injury. The organisers reserve the right to postpone the race.
Signature of participant
(all person(s) willing to participate in the event MUST sign this waiver)
Participants must have their race numbers on them before taking part in the race.
* Return this form to any Registration Centre. Call 020 2211896/97, 0731 015 276 for any registration enquiries
PERSONAL DETAILS
Full Names
Phone No.
ID/Passport No.
Race Distance
Amount Paid
T-shirt Size
Date
Stamp
Registration Venue
Customer Sign
*You must provide this as a receipt in order to receive your T-shirt & Race Number
REGISTRATION CLOSES ON
THE 27TH OF FEBRUARY 2015
MARATHON EXHIBITION
DATE : 28TH FEB - 6TH MARCH 2015
VENUE : KICC
ACTIVITIES: RACE NUMBER & T-SHIRT COLLECTION,
PHYSIO CLINIC, FREE MEDICAL CHECK-UP
& SPONSOR ENGAGEMENT
[email protected]
The Beyond Zero Campaign
Fo r mo r e i n f o r m at ion on h ow y ou can s u p p or t t h e B e y on d Z e r o C am p aig n , Kin dl y c ont ac t :
C h ar le s G ac h e r u , P R D ir e c t or - I MG Ke n y a
E m ail: cg ach e r u @ im g k e n y a. c om ; Ce ll 0737- 235- 138
@beyondzerokenya