World Diabetes Fun Run/Walk Entry Form

World Diabetes Fun Run/Walk Entry Form

Organized by the Swakopmund Lions Club and Dr Weder, Kauta & Hoveka Inc.
Participant Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Event will take place at the Yellow Bus where the weekly Park Run event takes place. Entry fee is N$50.00 and all proceeds will go to the Diabetes Pillar.

The first 100 entries will receive a unique keepsake medal.

Please where blue as this is the international colour for diabetes

You can either pay the registration fee day of the event or you can send it to our dedicated phone number for the event 081 247 4863. Please with your Name and Surname once you have done the payment.
Entry Fee is N$50
Signature of Participant or Legal Guardian

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