IMF RAW 2023 Championships Registration Form – Indigenous Marathon Foundation

https://www.youtube.com/watch?v=LG4bewN8adY

IMF RAW RUN LEADERS

2023 National IMF RAW Fun Run Championships

Mackay, QLD

1-4 June 2023

REGISTRATION & MEDICAL FORM

Please complete this by Friday 21st April 2023.

"*" indicates required fields

THIS INFORMATION IS STRICTLY CONFIDENTIAL AND WILL ONLY BE VIEWED BY YOUR RUN LEADER, THE DOCTOR, EVENT MANAGER & DIRECTOR OF THE INDIGENOUS MARATHON FOUNDATION.

I am attending the 2023 National IMF RAW Fun Run Championships as:*

RAW Community*

Name*

Address*

State*

Email*

Phone Number*

Date of Birth*

Gender*

ABOUT YOU

I AM:*

My mob/tribe/country is:*

What is the main language spoken at home?*

What is your country of birth?*

When did you join your IMF RAW/Deadly Running Group? What made you join?*

What is the longest distance (kilometres) you have run?*

What is your next running event?*

Have you had a health check recently?*

Which distance would you like to run/walk in the Mackay Marina Run?*

Do you have any dietary requirements?*

List your dietary requirements:*

IN CASE OF EMERGENCY PLEASE NOTIFY:*

Phone Number*

Relationship*

Address*

State*

Medical Information

Medicare Number*

Private Health Insurance*

Private Health Fund*

Doctor*

Doctor's Phone Number*

Current History

Do you have any medical conditions?*

If Yes, please list any current or pre-existing medical conditions you have.*

Are you taking any medications including prescription or supplements?*

If Yes, please provide name and dosage details.*

Use of medication is the individual's responsibility and IMF takes no responsibility for administering medications.

Do you have any allergies?*

If Yes, please provide details of any allergies.*

Do you have any sports injuries?*

If Yes, please list any current/recurring injuries.*

Signature*

Date*

Parent / Guardian Consent Under 18 Years of Age

Parent/Guardian Signature:

Date

Name

This field is for validation purposes and should be left unchanged.

IMG-20221120-WA0040

IMG-20221120-WA0041

IMG-20221120-WA0042

IMG-20221120-WA0043

IMG-20221120-WA0044

IMG-20221120-WA0045

IMG-20221120-WA0047

IMG-20221120-WA0146

IMG-20221120-WA0148

IMG-20221128-WA0000

Louise Ruhl Darwin

TI Deadly Runners and Walkers - Karen Keane

Darwin - Tash-Guse

Maroubra - Jason Webb

Mitchelton - Leesa Watego

Bramble Bay Tiana Brockhurst

DonM

Bramble Bay - Gabe Totchermann

Karatha - Natasha Leslie

Cairns - Fiona Millard

1F0F99EA-D417-49CB-B538-2507F947966F

Screenshot-2023-04-06-at-10.55.03-am

DE1F4636-1FE4-4164-B5B7-E746A05CE2F6

Have A Question? CONTACT OUR TEAM.

Contact Us

Email: kylie.y @ imf.org.au

(Please remove the spaces on both sides of the ‘@’ symbols when using this email address. The spaces were deliberately put here to prevent bots from doing malicious things)