Use the form below for a special online discount and pay by credit card with PayPal (you don't need to join PayPal) or
Download and print entry form for payments by cheque or
Enter on the day (to avoid delays on the day please consider the prior options for entering)
The entry form will be available again a month prior to the next event in August 2012.
I agree to abide by all race rules and directions of all the race officials, organizers on the day of the race.
I acknowledge that participating in a road race is a potentially hazardous activity and can result in serious injury and death from various causes, including over-exertion, dehydration, accidents with other competitiors, spectators or road users, and course of weather condition – to name a few.
In consideration of your acceptance this entry, I for myself or anyone entitled to act on my behalf, waive and release from any and all claims for injuries and damages I may have against the Prom Country Challenge Inc., South Gippsland Shire, Vic Roads, St. Johns, CFA, SES, Victorian Police and all other groups and individuals associated with the conduct of the event, the sponsors their agents & representatives caused by the negligence of any of them arising our my participation of the event, including pre and post race actitivities.
I attest that I am physically fit and I have trained appropriately for completion of my chosen event in the Prom Country Challenge.
I consent to receive medical treatment that may be advisable in the event of illness or injury suffered by me during the event and I agree to pay for the costs of medical treatment if required.
I have entered on/attached to my entry form details of any medical or physical conditions from which I suffer that might affect my performance or be relevant if medical treatment is needed. If I become ill or injured during the event, I will withdraw form the event.
I consent to any publication and or use in any form of media, of my name, image, voice, statement or otherwise, before, during or after the event whether for advertising, promotion or otherwise, without payment or compensation.
Athletics Australia insurance compulsory clause
By entering this event, you consent to your personal information being provided to Athletics Australia Ltd and Athletics Victoria for the purpose of registering you as a recreational running class of member of Athletics Victoria and for administering the Running Australia program. You further consent to receiving information (including via email) about the Running Australia program including details of other events and special offers or promotions. If you DO NOT consent to your personal information being disclosed and used or receiving information about the Running Australia program please tick the box at the bottom of the form.