durrell dash application form 13-09-11
DESCRIPTION
Durrell Dash application form 13-09-11TRANSCRIPT
All persons participate at their own risk. Durrell Wildlife Conservation Trust, its employees, officers and representatives, shall not be liable for any injury or accident whatsoever and howsoever occurring to participants or their guests nor for any loss or damage to, or theft of, their property at the event.
By participating in this event you irrevocably declare that you accept the above terms and absolve absolutely Durrell Wildlife Conservation Trust, its employees, officers and representatives from, and indemnify them for, any fault whatsoever from any injury, accident, loss, damage and/or theft which may occur of and incidental to your participation.
Durrell Wildlife Conservation Trust is a member of the Association of Jersey Charities, membership number 69. Patron: HRH The Princess Royal. Founder: Gerald Durrell, OBE, LHD. Honorary Director: Lee Durrell, MBE, BA. PhD. Chief Executive Officer: Paul Masterton.
Official Use: No Date:
Durrell Dash 2011Sunday 16th October 2011
The 13k Dash in and around Durrell Wildlife Park.New for 2011, The Durrell 6k Dash -now there is no excuse!
Durrell Dash 2011 map Sunday 16th October 2011
La Rue des Picots
des Cateaux
La Rue
de la FosseLa Rue
La Rue du Clos FalluLa Rue des Alleurs
La Gra
nde Route d
e Rozel
La Rue de la Maitrerie
La Route d
e Ma
ufant
Rue du Pont
Victoria Village
Rue de
Die
lam
ent
St. Martin’s Arsenal
START/FINISHDurrell Car Park
•
La Profonde Rue
La V
erte
Rue
�
� �
�
�
�
�
�
�
�
�
�
Sponsored by
The Madagascar giant jumping rat This large nocturnal, forest-dwelling
rodent is threatened with extinction because of its limited distribution
and loss of habitat. It also lends its name to the islands main marathon.
Route is subject to change
Name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Race Number . . . . . . . . . . . . . . .
Name Address Post CodeAmount Pledged
Date Collected
The named person is participating in the above event and seeks your sponsorship. Funds raised will be used on our projects both overseas and at our headquarters in Jersey. Every little helps for wildlife conservation and we are most grateful for any donation. For more information please contact the Fundraising Department on 01534 860000.
In order for Durrell Wildlife Conservation Trust to collate Gift Aid donations, please return this completed sponsorship form with all donations made.
The government’s Gift Aid scheme allows UK registered charities, such as ourselves, to raise vital extra funds by reclaiming the tax paid on donations by UK taxpayers. This means that every £1 you donate will be worth an additional 28p to us. Please note that tax can only be reclaimed on donations made by individuals who pay UK income or capital gains tax and are at least equal to the amount reclaimed on the donations in the current tax year.
Name. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Postcode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Email . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Durrell member Yes No
Phone number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Date of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . Age . . . . . . . . . . . . . . . . Sex . . . . . . . . . . . . . . . . . . . . .
Signed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Date . . . . . . . . . . . . . . . . . . . .
T-shirt size S M L XL
Registration/Late entry: 7.15 am
Pre race warm up: 8.15 am (13k Dash) 8:45am (6k Dash)
Start times: Durrell 13k Dash – 8:30am Durrell 6k Dash – 9:00am
Route: 13k Dash through Trinity, St Martin and St Saviour 6k Dash follows same route excluding the southern loop
Awards: Top 3 in each Dash Women & men’s open / Masters (W+35, M+40) All entrants will receive a ‘goody bag’ and t-shirt
Entry fee: Adults £10.00 closing date 7th October 2011 Entry on the day £20.00 Juniors (under 18) £5.00 in advance or £10 on day
Enquiries: Andrew Scott-Miller (01534) 860035 [email protected]
Please send completed forms to:Andrew Scott-Miller Durrell Wildlife Conservation Trust Les Augrès Manor, La Profonde RueTrinity, Jersey JE3 5BP Channel Islands
Payment:
The entry fee for each event is Durrell Dash Distance
Adults £10.00 6k 13k
Juniors £5 (under 18) 6k 13k
Charity donation £
Please make cheques payable to ‘Durrell Wildlife Conservation Trust’
Enter and pay online at durrell.org/dash
✁
Durrell Dash sponsorship formSunday 16th October 2011
Durrell DashSunday 16th October 2011
Sponsored by
✓