Cork City Marathon

Title:

First Name(s): *

Last Name: *

Address

Please enter your full address

Address 1: *

Address 2:

Town/City/Townland: *

County:

Postcode:

Country: *

Nationality: *

Irish Mobile Number

Mobile Prefix:

Mobile Number:

Other Phone Number:

Email: *

Date of Birth: *

Age: *

on 4th June 2012

Gender: *

T-Shirt size: *

Team Details

Runner 2

First Names(s):

Last Name:

Age:

on 4th June 2012

Gender:

T-Shirt size:

Runner 3

First Names(s):

Last Name:

Age:

on 4th June 2012

Gender:

T-Shirt size:

Runner 4

First Names(s):

Last Name:

Age:

on 4th June 2012

Gender:

T-Shirt size:

Runner 5

First Names(s):

Last Name:

Age:

on 4th June 2012

Gender:

T-Shirt size:

Team Name: *

Number of runners in team: *

Team Category: *

All female

All male

Mixed team

Special Category for organization with the most teams:

If you and your team are part of an organization (including community
groups, charities, sports & leisure clubs, businesses, hotels, etc.), please name

Best time for previous Relay (if applicable)

Hours:

Minutes:

Predicted Time

Hours:

Minutes:

Are you a member of the AAI?:

Yes

Are you a member of the BHAA?:

Yes

If you are running for charity, please name:

Emergency Contact

Emergency Contact Name:

Emergency Contact Phone Number:

If you are a member of a running club, please name:

Please specify any medical conditions you or your team member(s) may have:

Inter-Services Championships

Service:

Unit:

Are you participating in the Team Relay Event for a special reason?:

Would you be willing to speak to the Organisers and/or local media about your reasons for participating in this event?:

Yes

What experience do you have of similar events?:

Would you be willing to speak to the Organisers and/or local media about your previous experiences?:

Yes

How did you hear about the marathon?:

Other:

Photographers:

No Thanks

Cork City Marathon may pass names and email addresses on to a third party who will be taking photographs during the race. If you do not want your email address passed on, please tick the box.

Terms & Conditions of Entry
I declare that I will be 18 years of age or over on 4th June 2012 and that I will abide by the laws and rules of the Athletics Association of Ireland (AAI). I will not compete in the race unless I am medically fit to do so on the day and I accept that I will be participating entirely at my own risk. I accept that Cork City Council, its Servants or Agents, the Cork City Marathon Committee, its Members, Associates, Partners and Sponsors will not be liable for any loss, damage, illness or injury whatsoever directly or indirectly occasioned by or resulting from the negligence, wrongful act or default of Cork City Council, its Servants or Agents, the Cork City Marathon committee, its Members, Associates, Partners or Sponsors, or from any other cause including an act of God or my own physical condition. I accept that the Organisers, their Sponsors and Partners will not be liable for any action, claim, costs or expenses that may arise in consequence of my participation of the event.

By entering, I give my permission to Cork City Marathon to use my name, quotes and photographic likeness (and those of my
team members) for promotional and marketing purposes.

As the Captain of the team, I accept the terms and conditions of entry on behalf of my team members and undertake to make them aware of the requirements.

I accept the Terms & Conditions: *

Yes

High visibility version - Cork City Marathon

Sponsored by Bord Gais Energy.

Cork City Marathon

Cork City Marathon - Team Relay

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