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Details

2024 Chemist Warehouse Australian Cross Country Mixed Relay Entry Form

Sat 31 Aug 2024 08:00 — Sun 01 Sep 2024 13:30

Symmons Plains Raceway, 14872 Midland Hwy, Perth TAS 7300

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Basic details

First name*

Last name*

Phone number*

Email address*

Address*

Team Name (eg club name, training group name, School, University)*

Age Group*

Athlete Name #1 (Male)*

Athlete Name #2 (Female)*

Athlete Name #3 (Male)*

Athlete Name #4 (Female)*

State*

Name - Team Contact Person*

Phone Number - Team Contact Person*

Email - Team Contact Person*

Please note

I am over 18, or, if I am under 18, this registration has been filled out by and endorsed by my parent or guardian.*