TravellingFit

Title*

Firstname*

Lastname*

Email address*

Date of Birth*

Phone*

Gender*

Male Female

Address*

Marathon

$175

Half Marathon

$140

11km Fun Run

$85

6km Fun Run

$75

Entries MUST be collected in person between 4pm and 5pm on Friday 29 July at the Town Square park
Proof of residency MUST be provided when collecting your race entry
All entrants are required to attend the mandatory race briefing at 5pm on Friday 29 July at the Amphitheatre

I have read and agreed to the Terms and Conditions and Exclusion of Liability

Credit Card Direct Debit

Payment Amount

Plus credit card bank fee

VISA

Mastercard

AMEX

Diners

Cardholders Name

Card Number

Expiry Date (mm/yyyy)

CVV

Your CVV number is the 3 or 4 digits on the back of your card.

Account Name:

Travelling Fit

Bank:

National Australia Bank

BSB:

082-574

Account Number:

41-846-7265