SU Australia : Register

Personal Details

Title *

First Name *

Last Name *

Alternate display name *

Email Address *

Password *

Mobile *

Date of birth *

Gender *

Male Female Other

Dietary Requirements

Postcode *

Postal Address

(enter address manually)

State

Country

Emergency Contact Details

Please provide us with an emergency contact

First Name *

Last Name *

Contact Number *

Relationship to you

Create a Fundraising Page

Customise your fundraising page using the options below.

Fundraising Target

$

Indicate 33km, 66km or 100km

Fitness target (kms)

Create or Join a Team

No Thanks Create a team Join a team

Medical Conditions

Please provide details on any medical conditions that may affect your entry.

Do you have any pre-existing medical conditions which might affect your ability to take part, or be relevant if treatment is needed?

Please provide details

Your Agreement with Hervey Bay Chaplaincy Committees and Scripture Union Australia I am aware in signing this document for my participation this program that certain elements of the program could be physically and emotionally demanding. Furthermore, I understand that certain inherent risks and dangers may exist in the activities in which I will be participating. I acknowledge that while Scripture Union and its leaders will make every reasonable effort to minimise exposure to known risks, all hazards and dangers associated with these activities cannot be foreseen or may be beyond the control of Scripture Union, its leaders and staff. In the event of any emergency where my nominated contact people are unavailable: • I authorise the leaders to obtain medical advice and/or assistance which they deem necessary. • I further authorise qualified practitioners to administer anaesthetic if required. • I accept all operation, blood transfusion and/or anaesthetic risks involved in the event that such procedures are deemed necessary. • I accept the responsibility for payment and agree to pay medical, transport and any other related expenses. • I confirm that the information contained in this application is true and correct. • I agree to inform the leader of any change to these details.

I agree to the above Terms & Conditions *

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