Participant full name*

Address*

City*

Postal Code*

Telephone*

Email*

Approximate pace group*
—Please choose an option—22km/hr – 25km/hr26km/hr to 28km/hr29km/hr – 30km/hr

Distance*
—Please choose an option—35km route75km route

Dietary Preferences/Restrictions, Allergies or Health Concerns*

Emergency contact:

Name*

Telephone number*

Email*