Tāne Run Club Registration

1

Full Name* This field is required.

First Name

Last Name

2

What is your age?* This field is required.

4

Contact Number* This field is required.

Area Code

Phone Number

5

Which suburb do you live in?

6

Email Address* This field is required.

example@example.com

7

How much running experience do you have?(1= none, 5=expert)

8

Do you currently have any injuries?* This field is required.

Yes

No

9

If yes, please list them.

11

Are your conditions hazardous to your participation in the Run Club?* This field is required.

Yes

No

12

Are you currently taking any medication?* This field is required.

Yes

No

13

Please list them.

15

Emergency Contact* This field is required.

First Name

Last Name

16

Emergency Contact Phone Number* This field is required.

Area Code

Phone Number

17

Do you have transport?* This field is required.

Yes

No

18

Do you consent to your photo being taken and shared for promotional and/or reporting purposes?* This field is required.

Yes

No

19

To keep updated and connected, we will add you to the Facebook Messenger group chat. What is your Facebook name?