Please contact EMG on 01590 670 999 if you have any problems registering for your event online.

Email Address *

Name *

Company Name *

Work Telephone Number *

Mobile Number (for use on day of event only) *

Event Date (dd/mm/yyyy) *

Event Code *

Next of Kin (in case of emergency) *

Next of Kin Contact Number *

Do you suffer from any of the following?
 Heart Condition Asthma Epilepsy Allergies Diabetes Other Relevant Condition

If you answered 'Yes' to any of the above please give details and instruction for any special medication

Do you suffer with problems to any of the following areas?
 Neck Spine Hips Knees Other

If you answered 'Yes' to any of the above please give details and instruction for any special medication

Sex *
 Male Female

If female are you pregnant *
 Yes No

Can you swim (Relevant for water based events only)? *
 Yes No

Size of clothing (for wet weather gear) *
 Small Medium Large Extra Large

Do you have any dietary requirements? *
 Yes No

If you answered 'Yes' to above please give details below

Any other comments

I believe, to the best of my knowledge, all information to be correct
 Yes