Walk to `D

Brisbane
Walk to ‘D-Feet’
Motor Neurone Disease
Sunday 3 May, 2015 | 10am
Join us at Roma Parklands, Brisbane,
to raise awareness of MND and help ‘D-Feet’ its
impact in Queensland.
Registrations
open at 9am
EVENT DETAILS
REGISTRATION FEES
 3km (approx.) around
Roma Parklands
 Adults with T-Shirt - $30,
without T-Shirt $25
 Wheelchair, stroller and dog
(on leads) friendly
 Children with T-shirt - $12,
without T-shirt $8 (children
under the age of 14 must be
accompanied by an adult)
 Harley Davidsons display
from the Gasoline Alley HOG
Group
 Post event sausage sizzle and
music by a local band
 PUT A TEAM TOGETHER!
EVERYONE WELCOME!
Funds raised will go towards supporting people
with MND and research to find a cure
TO ENTER
For registration form see back of
poster or enter online at
www.everydayhero.com.au/event/
walktodfeetbrisbane2015 or if you
are unable to enter online, please
contact MND Queensland on 3372 9004, freecall 1800 777 175
or email [email protected]
Registration Form
Please complete details for each participant and mail form and entry
fee to: Walk to D-FEET MND, PO Box 1039 Inala East, QLD, 4077, or
fax 07 3278 9871
ENTRY FORM (Please print details in capital letters)
Name_________________________________________________________________________________________________________________________________________________________
Address_____________________________________________________________________________________________________________________________________________________
Suburb_____________________________________________________________________ Postcode___________________________________________________________________
Thelephone_______________________________________________________________ Email_________________________________________________________________________
ENTRY FEES
ENTRY FEE
NUMBER
COST
Adult with t-shirt $30 without t-shirt $25
Child 5-16yrs with T-shirt $12 (children under the age of
14 must be accompanied by an adult) without t-shirt $8
My Donation (over $2 tax deductable)
Postage if required $10
TOTAL PAYABLE
METHOD OF PAYMENT  Cheque/Money order
 Cash
Card number
_ _ _ _ _ _ _ _ (Please make payable to MND Queensland)
 Visa
 Mastercard
_ _ _ _ _ _ _ _
Name on card ___________________________________________________ Expiry Date __________________________ Signature ______________________________
IMPORTANT
By registering for the Walk to D-FEET
MND, you:
agree that MND Queensland shall
not be held responsible for any loss,
damange or injury arising for the Walk
to D-FEET MND
T-SHIRT REQUIRED have physical fitness to safely
complete the Walk to D-FEET MND
consent to recieve medical treatment
if deemed advisable
folow instruction given by event
organisers
have sole responsibility for your
personal possesions and equipment
agree that the entry fee is non
refundable
permit free use of your photograph in
print and electronic media
(Please indicate the number of t-shirts required in the box next to the sizes required)
Name________________________________________________________________________ Surname___________________________________________________________________
Adult sizes
2XL
XL
L
M
S
Children sizes
14
12
10
8
6
4