The Heritage Burnie Ten

Team NamePlease enter your team name

Team Type

Team Numbers

EmailPlease enter your email address

Confirm EmailEmail address does not match

Given NamePlease enter your street address

SurnamePlease enter your street address

Street AddressPlease enter your street address

City/TownPlease enter your town or city

PostcodePlease enter your postcode

StatePlease select your state

Phone (No spaces)Please enter your phone number

Residential Address

Please select if your residential address is different to your postal address

Gender

Male Female

Date of Birth

Day

Month

Year

PB for 10km

Hours

Minutes

Seconds

Pram or a child conveyancing device

Child's namePlease enter the child's name

Child's age Please select the child's age

Child's name

Child's age

First time Burnie Ten entrant

DO NOT wish to receive any future marketing or promotional material

I declare that team entrants in The Heritage Corporate Challenge are bonafide and genuine employees of the named business/organisation and that entrants competing in the Schools Challenge are bonafide and genuine students of the named school. I understand event organisers will make every effort to provide a true and accurate time in accordance with IAAF rules. However in the event of a systems failure, or errors occurring, I agree not to hold event organisers liable. Any timing protests or objections must be lodged 72 hours after the race, after which race times will become official.

Refund & re-issuing Policy: 
I understand that due to administrative costs and associated race consumables refunds will not be issued. Re-issuing of a race bib will incur a $10.00 fee.

I have read the disclaimerPlease read the disclaimer and check the box