Russell Birdman Festival - Online Entry Form

Entry forms, music and payment need to be completed & returned by 8th July

First name *

Surname *

Email *

Address *

Mobile Phone Number *

Have you had previous experience as a Birdman? Yes or No

yes no

Do you have a soundtrack to be played in conjunction with your entry? Yes or No (If yes please ensure that your choice of music is e-mailed to us with your entry by July 1st

yes no

Name & describe your Birdman entry.

Everyone who is on the wharf as part of the jump routine needs to read and sign a disclaimer – they need to do this on the day of the Birdman Jump. All jumpers and partisipants should report to Birdman HQ on the 'jump day' before midday.

DISCLAIMER:

I enter this event at my own risk.

I have read and agree to be bound by the rules of the Russell Birdman Festival.

I will not hold any of the organizers or any sponsor responsible for any accident, injury, loss or damage to myself or my property arising from participation in this event.

I understand to the best of my knowledge that I am in good physical and mental health and suffer no medical conditions or disabilities which may render me unsuitable for any of the activities.

I understand that all activities are voluntary, and I do not have to participate unless I choose to do so.

I participate in this event purely at my own risk.

I acknowledge that I have read and understood the effect and intent to this waiver of my rights.

I have read and agree to the disclaimer

Yes

PAYMENT

Entry Fee; Earlybird $30 before 1st July

After 1st July: $40

Entry forms to be completed & returned with payment by 8th JULY 2018
You can also enter online via the website www.russellbirdman.co.nz
Cheques can be made out to Russell Birdman Charitable Trust
Online banking payments can be paid into the Russell Birdman Charitable Trust
Direct Credit (03 0394 0132646 00)
Reference – Team Leaders name and jump.
Entry form & all enquiries/correspondence to;

e-mail info@russellbirdman.co.nz

Or c/o 11 Beresford Street Russell

Every person in the entry – even if they are not jumping must register on the Saturday 14th July and read and sign disclaimer form