BAC Registration — Ballina Athletics Club

Household Details

Primary Contact Name Please enter the primary contact name.

Phone

Email Please enter a valid email address.

Membership Type

Single/s Membership$30 per person Family Membership$70 — covers all household members

Please select a membership type.

Total Amount Paid ($)

Receipt / Transfer Reference Please enter a receipt or transfer reference.

Would you be willing to volunteer?

Yes, I am willing to volunteer No, not this season

Participants

Participant 1

Full Name Please enter a full name.

Date of Birth Check the date of birth.

Sex Please select a sex.

Prefer Cash or Trophy?

Do you already have a bib number from a previous season?

Yes No

Bib Number (hint only — for coordinator reference) Digits only please.

Do you have another participant to add?

Declaration

Ballina Athletics Club — Waiver and Declaration

I/We acknowledge that participation in Ballina Athletics Club cross-country events involves inherent risks of physical injury. I/We agree to participate at my/our own risk and release Ballina Athletics Club, its committee, volunteers and officials from any liability for injury, loss or damage.

I/We confirm that all participants are fit to participate and that the information provided is accurate. I/We agree to abide by club rules and the decisions of club officials.

I have read and agree to the declaration above. You must agree to the declaration to continue. I confirm all family members listed reside at the same address. You must confirm household residency to continue.

Registration

You're registered!