Virtual Individual Adult Entry

Participant First name

Participant Last name

Participant Gender

MaleFemaleNon-Binary

Participant Date of birth

Minimum 18 years old

Reflective Jacket (Adult Sizes - Standard fit)

E-mail

Confirm e-mail address

Have you participated in the Night Run before?

YesNo

You can choose to either pick up your race pack from our address below or pay to have it delivered to you in the post.

Croí, The West of Ireland Cardiac and Stroke Foundation
Address:

Croí House,

Moyola Lane,

Newcastle,

Galway, H91 FF68

Race Pack Pick Up or Postage

Race Pack Pick Up Single Race Pack Postage [+ 5.95 €]Multi Race Pack Postage [+ 10.5 €]Multi-Pack Postage paid by someone elseInternational Pack Postage (Outside of Ireland) [+ 15.95 €]

Address line 1

Address line 2

Eir Code / Postal code

City / Town

County

Country

Phone Number

Declaration & Disclaimer

I understand that participating in the Croí Night Run event is potentially hazardous, and that I should not enter and participate unless I am medically able and properly trained. In consideration of the acceptance of this entry, I assume full and complete responsibility for any injury or accident which may occur while I am travelling to or from the event, during the event, or while I am on the premises of the event. I also am aware of and assume all risks associated with participating in this event, including but not limited to falls, contact with other participants, effect of weather, traffic, and conditions of the road. I, for myself and my heirs and executors, hereby waive, release and forever discharge the event organisers, Croí, the West of Ireland Cardiac & Stroke Foundation, Ltd, sponsors, promoters and each of their agents, representatives, successors and assigns, and all other persons associated with the event, for all my liabilities, claims, actions, or damages that I may have against them arising out of or in any way connected with my participation in this event. I understand that this waiver includes any claims, whether caused by negligence, the action or inaction of any of the above parties, or otherwise. I hereby grant full permission to any and all of the above parties to use any photographs, videotapes, motion pictures, website images, recordings or any other record of this event. I confirm that I DO NOT have any injury, disease or medical conditions that would prevent me from taking part in the Croí Night Run event or endanger myself or any other participant. I understand the nature of the Croí Night Run and I fully accept that I take part totally at my own risk

Where did you hear about this event?

Would you like to add an Additional Donation to Croí

YesNo

Croí would like to occasionally contact you to provide updates and let you know how you can support our mission. Please use the options below to select how Croí can interact with you. You can withdraw your consent at any time.

Opt In

Opt In – Opt-In to receive email communications from CroíOpt In - Allow us to occasionally send you postal mailI DO NOT wish to hear from Croí

We will automatically create an iDonate.ie fundraising page for you which will be emailed to you upon registering to use if you would like to raise more funds for the event.

I understand that I have signed up for the virtual event and not the physical event in Salthill. As we have a limit on numbers, please note that all participants at the physical event will require a wrist band and race number to gain entry.

Agree

I understand that this is a Virtual Event

iDonate

No Thank You, Maybe LaterCroi

Croí Virtual Night Run 2023