Pilgrimage
AugustSeptember

First name*

Last name*

Date of Birth (day - month - year)

Street Address

Suburb

Postcode

State

Phone

Your email*

Gender

Next of Kin (Not attending the walk)

Next of Kin Relationship

Next of Kin phone number

Room Pairings. 2, 3 or 4 share when available. Enter names below.

Medical Issues

Special Diet (If option isn't available, then self catering is required)
NoneGluten FreeVegetarian

1st Aid/medical qualifications.

Do you require a Hi-Vis jacket or waistcoat (All walkers must wear one)
YesNo

Disclaimer.
You agree that you undertake the walk entirely at your own risk and will not hold others responsible or liable for any loss, injury, claim, liability or damage of any kind whatsoever, for the duration of the
pilgrimage.
You understand that the walk involves sustained physical exercise in some remote areas, and that you are responsible for your own fitness and for consulting a doctor about your participation if necessary.
You agree to wear a High Visibility jacket at all times whilst walking.
You understand that the facilitators may need to cancel, halt, delay, or re-route the event in response to hazards including extremes of weather, fire, flood or path instability. In such instances, you will be given as much notice as possible, and any necessary alterations will attempt to preserve the nature of the event.
YesNo

Additional message (optional)

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