TravellingFit

Title*

Firstname*

Lastname*

Email address*

Date of Birth*

Day

Month

Year

Phone*

Gender*

Male Female

Address*

Marathon

$175

Half Marathon

$140

11km Fun Run

$85

6km Fun Run

$75

Would you like to attend the Carbo Load Dinner - $90? Yes No

Entries MUST be collected in person between 3pm and 5pm on Friday 25 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 25 July on the grass near the Town Square

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

Credit Card

Amount Payable

Credit Card Fee

Total Amount Payable

Cardholders Name

Card Number

Card Type

Expiry Date (mm/yyyy)

CVV

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