REGISTRATION & ARRIVAL DETAILS
LAST NAME______________________________(As on Passport)
FIRST NAME_____________________________
MALE__ FEMALE__
AGE ON RACE DAY __________ I am a Participant__ I am a Supporter___
My T Shirt Size is : - Small Medium Large XL XXL
Postal Address: ______________________________________________
_____________________________________________________________
_____________________________________________________________
______________________________________________
Country ______________________________________________
Email Address ______________________________________________
Phone ______________________________________________
Fax ______________________________________________

EDGEWATER ROUND RAROTONGA ROAD RUN
I would like to enter in the following Events / Categories on Sept 24:
2011 ERRR Round Island Walk__ 10km Run__ 10km walk__
I would like to enter in the following Age Group Category
Open Men Men 40-49__ Men 50- 59__ Men 60 � 69 Men 70+__
Open Women�s Women�s 35 � 44__ Women�s 45 � 54__ Women�s 55+__
I would also like to Pre Register for the
following events
5km Run__
Round the Rock Relay__
Coco Bar Nutters Cross Island Run__
Hash House Harriers Birthday Run__
Round Aitutaki Road Race___

Please Send $300 Deposit to Reserve
Final Payment Due July 15
PAYMENTS
I wish to pay by M/Card Visa Check  (3% Fee)
Credit Card Number ______________________________________________________________________
Name on Card and Billing Address_____________________________________________
Expiry Date _______/ ______ / ______
Security Code ____
Please fill in this form and fax or Mail to
Sue Rudolph
Absolutely Amazing Travel
9841 Villa Pacific Drive
Huntington Beach, CA 92646
Fax (714)963-3451

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