Funrazor 08

Please complete this form to register to participate in funrazor

Information such as title, and date of birth, is required to help to identify you, and is also used for statistical purposes by the Child Cancer Foundation. Thank you for your understanding when filling out this form!

All money raised goes to the Child Cancer Foundation for helping to fund programs for kids and their families on the childhood cancer journey. PO Box 152 Auckland 1030 Telephone 09 373 3670 Facsimile 09 373 3673 www.funrazor.org.nz

Title	*
First Name	*
Middle Name
Surname	*
Date of Birth (dd/mm/yyyy)	*
Address 1	*
Address 2
Suburb	*
City	*
Post Code
Please select the region/event you wish to register for:
	*
Home Phone Number	*
Mobile Phone Number
Email Address	*
Please email me an electronic sponsorship pack
How did you hear about funrazor
FriendBillboard RadioChild Cancer Foundation MagazineFrom a Family affected by Child Cancer NewspaperI have participated in a funrazor before PosterOther
I grant full copyright and all rights to funrazor® of photograph/s and video footage taken of me during the funrazor® event and consent to their use in editorial, advertising, trade or for any other legal purpose, without reservation. I am authorised to give this consent of release which shall be binding upon me or my heirs or any legal representative in perpetuity. I understand that my details will be added to the Child Cancer Foundation's database so they can send me a certificate and follow-up newletter. If I am under 18, in accepting these terms and conditions I am stating that I have sought and gained approval from my parent or guardian to participate in this event, and that they would be prepared to supply this approval in writing should it be requested by a representative of the Child Cancer Foundation.
I accept the above terms and conditions