Coastrek Entry

• You must complete ONE Entry Form per team,
• Each individual in the team needs to complete a Risk Waiver.
•  If your exact team is not confirmed, or if your team members change prior to the event, you will need to complete a Change of Team Member Form on the event day.
• Please Note: Coastrek Entries are now FULL. If you would like to be submiitted on a waiting list, please submit your team details and we will contact you should a place become available. Payment can be made at a later date should your place be confirmed.
•  No refunds will be offered.
• Pay by Credit Card HERE
• Pay by Bank transfer to: Wild Women on Top; BSB 062 207; ACCOUNT 1021 5502 using your Team Name as reference
• Please read the Rules and Guidelines of Coastrek before submitting your entry.

Today's Date*

(DD/MM/YYYY)

Team Name*

Category*

100km Team of 4 100km Relay Team of 6 50km Team of 4

Team Captain's Name*

Team Captain's Contact Number *

Team Captain's Email address*

(email address)

Team Members Names*

Your Name (if different from captain)

Your email (if different from captain)

I have paid my team's entry fee of*

$788 team of 4 $1182 team of 6

Payment Date

(DD/MM/YYYY)

Are you currently a Wild Women on Top Member?*

YES NO

I agree to the Rules and Guidelines of Coastrek *

YES

Verify*