GUN RUN - Top Events

2012 OUTsurance 94.5 Kfm Gun Run Entry Form
PLEASE TICK BOX 21.1km HALF MARATHON 10KM RUN/WALK 5KM RUN/WALK
Age Categories JUNIOR* 20-39 40-49 50-59 60-69 70+
*(16 to 19 yrs 21.1km) (15 to 19 yrs 10km)
ID no:
Surname:
First Name:
Postal Address:
Postal Code
Tel no. Home:
Cell no:
Tel no. Work:
E-mail Address:
Date of birth: Age on race day: male: female:
Do you belong to an athletic club Y N
Athletic club:
2012 Licence NUMBER:
Racetec chip No*:
HOW MANY 21.1KM GUN RUNS HAVE YOU COMPLETED PERMANENT NO (IF APPLICABLE):
FIRST 21.1KM: Y N SHOE BRAND:
OFFICIAL RACE T-SHIRT: Y N TICK SIZE: S50 M53 L56 XL59 XXL61
NUMBER COLLECTION:
Sportsmans Warehouse
Rondebosch
Sportsmans Warehouse
Somerset Mall
Sportsmans Warehouse
Tygervalley
Sportsmans Warehouse
Canal Walk
(Chest size armpit to armpit
in cm)
hamiltons rfc green
point
Contact in case of emergency:
Cell no:
*RACETEC TIMING SYSTEM FOR THE 21.1KM:
You must have a RaceTec chip for the half marathon. RaceTec timing chips are used at the Old Mutual Two Oceans Marathon and
the Cape Argus Pick n Pay Cycle Tour. No other chip is acceptable. If you already own a RaceTec chip, enter your chip number (on
the exterior of the chip) on the form. If you do NOT own a RaceTec chip, you MUST purchase one when you enter the Gun Run Half
Marathon. Chips are available for R100 (usual price R120). You can collect your chip with your race number at registration. You can
use your unique chip for this and future timed events which use the RaceTec system. The chip must be placed VERTICALLY and
not horizontally on your shoe laces in order to be read over the timing mats. NB: You MUST wear your RaceTec chip when you run
the Gun Run Half Marathon. If you don’t wear your chip you will NOT be listed as an official finisher or receive an official time and
you will NOT qualify for prize money or have your participation added to your race history.
NB Chips are NOT required in the 10km and 5km events.
FAX ENTRIES:
Deposit in favour of “Atlantic Athletic Club Gun Run.”
Absa Heerengracht; Account No: 4062598007.
Branch Code: 506009
Attach deposit slip to entry form and fax to:
(021) 510 7230 or 086 628 3061
E-mail:
E-mail attached scanned copy of the entry form together
with proof of payment to info@topevents.co.za
(Please do not fax or e-mail your entry more than once)
POSTAL ENTRIES/CHEQUES:
Crossed cheques and postal orders to be made payable to:
“Atlantic Athletic Club Gun Run”
Postal Address: P.O. Box 44, Maitland, 7404.
Online entries:
www.thegunrun.co.za
RELEASE AND WAIVER
I agree not to hold Atlantic Athletic Club, OUTsurance, Primedia
(Pty) Ltd or any of the sponsors and any person assisting in
the organisation or holding of the race liable for any illness
or injury which I may suffer directly or indirectly as a result of
participating in the event or for any damage to my property or
loss of my property which I may suffer directly or indirectly as a
result of participating in the event.
I accept that this special agreement is entered into for the
benefit of Atlantic Athletic Club, the sponsors and the persons
assisting in the organisation and holding of the event.
21.1km Half Marathon
10Km Run / Walk
5km Fun Run / Walk
Entry fees
Club Members with
chip
Club Members
without chip
Non Club Members
with chip (including
temp licence)
Non Club Members
without chip
(including temp
licence)
Club Members/
Licensed
Non-Club Members
(incl temp licence)
R 65.00
R 165.00
R 100.00
R 200.00
R 40.00
R 60.00
Licensed Junior R 20.00
Unlicensed Junior
(incl temp licence)
All Categories.
No Licence required
R 30.00
R 30.00
Moisture Management T-Shirt R 155.00
Atlantic AC Membership Special 2013 (includes
2013 Licence). First time new members only.
R 200.00
2 prepaid photos from Jetline Action Photo R 95.00
Signature:............................................... Date:...........................
(PARENT/GUARDIAN IF UNDER 18 YEARS )
Charity Donation to JAG Foundation (optional).
TOTAL PAYMENT
R