Enter

Individual

$10

Single entries

4km

Starts at 11.00am

Download entry form

Enter online

Team

$30

Group of four

4km

Starts at 11.00am

Download entry form

Enter Team online

Online Single Entry Form for the 4km race starting at 11.00am

* First NamePlease enter your first name

* SurnamePlease enter your surname

* Mail Address Please enter your mail address

* Town/CityPlease enter your town/city

* PostcodePlease enter your postcode

* GenderFemaleMalePlease select your gender

* Phone NumberPlease enter your phone number

* EmailPlease enter your email address

* Date of Birth

Please select your day

Please select your month

Please select your year

Refund Policy

I understand that due to administrative costs and associated race consumables refunds will not be issued.

* Age Declaration
I declare that I am over 18 years of age
I declare that I am the Parent/Guardian of the person entering who is under 18 years of age and give my consent to the named person entering the eventPlease make a selection

Enter name of Parent/Guardian

* Participants Event Waiver Clause

(1) I understand the demanding physical nature of the event and have trained accordingly. I am not aware of any medical condition or impairment that will be detrimental to my health if I participate in this event. In the chance that I become aware of any medical condition or impairment, or am otherwise sick or injured prior to the event, I will withdraw from The Burnie Challenge.(2) I acknowledge that participating in this event may involve a real risk of serious injury or even death from various causes including: falls, illness, infection, contact or collision with spectators, or other participants or reserve users, contact and the effects of contact with natural and man-made fixed objects, over-exertion and dehydration. I agree that it is my responsibility to determine whether I am sufficiently fit, healthy, skilled and physically trained to safely participate in The Burnie Challenge.(3) I accept all risks and release the event organisers, its agents, affiliates, employees, members, sponsors, promoters, volunteers and any person or body, directly or indirectly associated with the event, from all claims, demands and proceedings arising out of or connected with my participation in this event and I indemnify them against all liability for all injury, loss or damage arising out of or connected with my participation in this event. This release continues forever and binds my heirs, successors, executors, personal representatives and assigns.(4) I grant permission for the Burnie City Council to use photograph and/or any other record of me or my child�s participation in the Burnie Challenge for any legitimate purposes and the right to sell and/or profit from the commercial use of such photographs, motion pictures, recordings and/or likenesses.

* Declaration

I accept the terms and conditions stated above.Please read and accept the terms and conditions

Payment

* Credit Card TypeVisaMastercardPlease select your credit card type

* Name on cardPlease enter the name on your credit card

* Credit card number (no spaces)Please enter your credit card number

* Expiry date

Please select your expiry date

* CCV NumberPlease enter your ccv number