Melbourne Cricket Club / Purewater 5K Run / Walk
Please complete the form below to provide details about your submission.
Full Name
*
First Name
Last Name
E-mail
*
Phone
*
Date of Birth
*
-
Day
-
Month
Year
Date Picker Icon
Gender
*
Female
Male
Are you registering to run or walk
*
Run
Walk
Participating as Team - Enter Team Name
Emergency Contact
*
Emergency Contact Phone
*
Please state any medical conditions
*
Back
Continue
Save
Please read the indemnity statement below and say if you agree with it. You will need to come in person to collect your bib and sign the indemnity form.
Indemnity (All Participants must agree to this Waiver):In consideration for me being permitted to participate as an entrant or competitor in this race, I, my heirs, executors and administrators hereby release, waive and keep indemnified Melbourne Cricket Club, and all clubs, associations, companies, sponsors, participants, competitors, entrants, and all of their respective agents and servants from and against all actions, claims, costs, expenses, demands in respect of death, injury, loss or damage to my person or property howsoever caused by arising out of my permission to attend at, or in any way participate during or subsequent to the said Melbourne Cricket Club / Purewater5K Run & Walk whether as spectator, participant, or competitor, entrant or otherwise, notwithstanding that the parties abovementioned their servants and/or agents may have contributed to the aforesaid injury, death or loss. Further, the participant grants full permission to any or all of the releases to use any photographs, video tapes, motion pictures, recordings, and any other record of this event for any legitimate purpose. Melbourne Cricket Club retains the property in all photographs, video and audio material arising from the event and reserves the right to use all such images and sound as it sees fit for legitimate purposes without the participant’s consent. If the participant is younger than 18 years old, the parent or guardian should sign the Indemnity. Signature:________________________________Date:____________ If you are under the age of 18, you must have a parent or guardian’s signature.
Please check
*
I agree
Back
Continue
Save
5K Run / Walk Event
*
prev
next
( X )
5K Run/Walk
2,500.00 JMD
2,500.00
JMD
Total
0.00 JMD
0.00
JMD
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
February
March
April
May
June
July
August
September
October
November
December
Expiration Month
Expiration Year
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
2044
2045
Expiration Year
Save
Submit
Should be Empty: