36th NZMA
Track & Field Championships

QEII Stadium
Christchurch
2nd - 5th April 2010

Official's Registration Form

First Name

Last Name

Address

Phone

Email

Official's Grade

Dinner & Social @ $30.00

Neither the organisers, the sponsors, nor other parties associated with the events shall have any responsibility for any liability, financial or otherwise, which might arise whether or not by negligence, from any direct or indirect loss, injury or death which might be sustained by me or any other party directly or indirectly associated with me, from my intended or actual participation in these championships or related activities. I authorise my name, voice or picture and any information on this entry form to be used without payment to me in any broadcast, telecast promotion, advertising, or in any other way relating to this event, pursuant to the Privacy Act 1993.