Please print out the form (or dowload it as a Word document) and complete in BLOCK CAPITALS
 
Name:- _________________________________________________ Sex:-__________
 
Address:-_______________________________________________________________
________________________________________________________________________
________________________________________________________________________
 
Country:- ______________________________________________________________
 
Phone:-________________ Fax:-________________ E-mail:-__________________
 
Nationality:-________  Passport No:-__________   Date of Birth:- _______
 
Home Hash:-________________________ Hash Name:- ________________________
 
Does your Hash wish to contribute a Hash act?	
(  )1st Night	 (  )2nd Night	 (  )3rd Night
 
Are you the Voting GM of your Hash, for the Interhash '98 Delegates Meeting?   
Yes / No (Circle)
 
Circle previous Interhashes attended ...
	'78/ '80 / '82 / '84 / '86 / '88 / '90 / '92 / '94 / '96
 
Circle T shirt size 38", 40", 42", 44", 46", 48", 50" ...  
Circle preferred run length S(45 min), M(1 hr. 15 min.), L(2 hrs.)
 

 
Registration Fees:-

For registrations received between January 1st 1997 and December 31st 1997
Personal Cheque US$157	 Bank Draft Money Order US$150
 
For registrations received between January 1st 1998 and August 31st 1998
Personal Cheque US$210	 Bank Draft Money Order US$200
 
For registrations received on or after September 1st 1998
Personal Cheque US$262	 Bank Draft Money Order US$250
 
I enclose my Bank Cheque / Bank Draft / International Money Order*, 
made payable to INTERHASH '98
No _______________ for US$_________________ Dated___________________
 
Please debit my Master Card A/C (only Master Card Cards Accepted)	
Issuing Bank ____________________________________
 
No. | | | | |x| | | | | |x| | | | | |x| | | | | |  
 
For US$______________ Expiry Date:______________

 
 
Please note that we will take the usual strict line with late, or incomplete registrations.

 



THE FINE PRINT

I understand that my consent to these provisions is given in consideration for being permitted to participate in this event. I am aware of, and voluntarily assume the risks of coming to this event.  If I am injured, I agree that I will not sue, or otherwise hold responsible,The Interhash '98  Organising Committee,or any affiliated individuals,or any run sponsor and/or their employees. In other words, I take responsibility for my own actions and I will not try to screw anybody connected with this event-and maybe, for the first time in my life,I will be responsible for myself and my actions.









Signature_______________________       	Date______________

 

(Please not that this form is not valid without a signature

and a date, and full payment of registration fees)

 

 
For Official Use only:
Date received_____________ Date entered________ Reg. No:____________
Remarks: ___________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________