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Registration form
Person filling in this form
Your Name
Your email address
Would like to register
Person ONE details
Register as
Full name of registrant
Gender
Date of birth
(dd/mm/yyyy)
Telephone
Emergency contact details
Name
Telephone
Medical Conditions:
Do you have a current or recurrent medical condition or are you on medication or suffer from allergies or reactions to medications?
Please list
Do you have any disability (statistical purposes only)?
Yes
No
Team:
"I'm part of team"
Yes
No
Male
Female
Person TWO details
Register as
Full name of registrant
Gender
Telephone
Emergency contact details
Name
Telephone
Medical Conditions:
Do you have a current or recurrent medical condition or are you on medication or suffer from allergies or reactions to medications?
Yes
No
Please list
Do you have any disability (statistical purposes only)?
Yes
No
Team:
"I'm part of team"
Male
Female
Date of birth
(dd/mm/yyyy)
Person THREE details
Register as
Full name of registrant
Gender
Telephone
Emergency contact details
Name
Telephone
Medical Conditions:
Do you have a current or recurrent medical condition or are you on medication or suffer from allergies or reactions to medications?
Yes
No
Please list
Do you have any disability (statistical purposes only)?
Yes
No
Team:
"I'm part of team"
Male
Female
Date of birth
(dd/mm/yyyy)
Person FOUR details
Register as
Full name of registrant
Gender
Telephone
Emergency contact details
Name
Telephone
Medical Conditions:
Do you have a current or recurrent medical condition or are you on medication or suffer from allergies or reactions to medications?
Yes
No
Please list
Do you have any disability (statistical purposes only)?
Yes
No
Team:
"I'm part of team"
Male
Female
Date of birth
(dd/mm/yyyy)
Person FIVE details
Register as
Full name of registrant
Gender
Telephone
Emergency contact details
Name
Telephone
Medical Conditions:
Do you have a current or recurrent medical condition or are you on medication or suffer from allergies or reactions to medications?
Yes
No
Please list
Do you have any disability (statistical purposes only)?
Yes
No
Team:
"I'm part of team"
Male
Female
Date of birth
(dd/mm/yyyy)
Details:
How did you hear about the event?  
If you selected “Other”, please advise
Please tick the opt-out box on the left, if you do not wish to receive information about upcoming events that Council believes may be of interest to you
Yes
No
Total Registration fee NZ$
Amount NZ$
Payment Reference
Status