This is the Latecomer registration form. 
This form is only valid when payment of $450 is received. See details below. Registration does not include entry to red dress run, this IS SEPARATE.
See Below for printable GRNH2017 registration form.

Name *
Name
Address *
Address
Please fill in your postal address.
Age Range *
Please select your age range. Note: Event is strictly 18+
Gender *
Please select gender, if known.
Telephone Number *
Telephone Number
Please enter your phone number.
Privacy Info
In accordance with national privacy principles, personal information on this form will be offered to the next host for the purposes of organising aussie nash hash 2019. However, opt out by ticking this box
What beverage is your preference?
Please select your shirt size.
Please indicate your run preference.
Previous Nash Hash Attended
Please tell us your food requirement.
Declaration *
I declare that I take full responsibility of all risks that may arise from my participation in Gold Rush Nash Hash 2017 (GRNH2017). By submitting this registration, I indemnify GRNH2017, its members, the organising clubs, any sub-committees or individuals, sponsors, employees or associates from any liability related to any injury or grievous harm that may arise as a result of my participation in GRNH2017.

Thank you for registering. We ask that your payment ($450) be in our bank by as soon as possible. Full Goodie Bag cannot be guaranteed for regos received after 31/12/16. Please do not pay in installments. 

Payment Details:

EFT to
Bendigo Bank
account name: Gold Rush Nash Hash
bsb: 633000  account: 154156640
(include your hash name in the bank's comments section and send an e-mail to GoldRushNashHash@gmail.com with details)

For international payments, you will also need:
SWIFT Code:      BENDAU3B
Address :        1 Main Street, Box Hill, VIC 3128, AUS.

OR

by cheque/bank draft/international money order payable to “Gold Rush Nash Hash” –
 
Post to :  Gold Rush Nash Hash,
               Po Box 298
               Heidelberg  Vic  3084 
               Australia

Pricing Tiers:

Latecomers priced at $450. Full Goodie Bag cannot be guaranteed for regos received after 31/12/16. Registration does not include entry to Red Dress Run, or accommodation in Ballarat.

Printable registration form:

Please click here for a printable registration form. IF you have filled out the above online form (PREFERRED) you do not need to complete a paper form. If you choose to complete a paper form please send to us by email, fax or post (details on Form) along with payment or confirmation of electronic payment.