Please fill in as much information as possible. Fields marked with an * are mandatory.

Once you have completed and submitted this page we will have your details on record. You will be sent confirmation of your registration by email.

*Please select an event:

Personal details

*Title:
Title if ‘other’:
*First name:
*Middle name:
*Surname:	Please enter your name as it appears on your passport
*Gender:
*Date of birth:
*Nationality:
Occupation:
*T-shirt size:

Address

*Address line 1:
Address line 2:
Address line 3:
*Town:
*County:
*Post/Zip code:
*Country:

Daytime phone:	–
Mobile phone:	–

*Email:

Passport

*Do you have a valid UK passport?	Yes No
Name as it appears on the passport:
Passport number:
Nationality:
Place of issue:
Date of issue:
Date of expiry:
Country of residence:

Corporate Team

You may enter a corporate team for the Namibia and Spanish Ultra races. If you wish to enter a corporate team, please complete the following:

*Team Name

Please detail team members below, with each person’s full Christian name and surname. The person completing this form will be assumed Team Leader. All correspondence regarding the race will be sent to the team leader for distribution to the rest of the team. Each team member will be required to read and sign our terms and conditions before their place in the marathon is confirmed.

Note: Max. team size for Spanish Ultra is 4; max team size for Namibia is 5.

Team Member 1:
Team Member 2:
Team Member 3:
Team Member 4:
Team Member 5:

Additional information

Is this your first marathon?	Yes No
*If you have answered ‘No’ to the above question, please list previous marathons entered and completion times:

Any special dietary requirements?	Yes No If yes, please specify:
*If you are entering the marathon with a friend please tell us their name (for roomshare):
Are you entering the marathon for charity?	Yes No If yes, please specify:
How did you hear about the Marathon?

Payment Options

Payment Option 1
I will pay the registration and insurance fee to sign up and secure my place on the trip and then pay the full tour cost 8 weeks prior to the trip. Then I’ll raise as much sponsorship money as possible for my charity and this can be done either before or after the trip.

Payment Option 2
I will pay the registration and insurance fee to sign up and secure my place on the trip. I will then raise a minimum level of sponsorship for my charity and in return my charity will pay the full tour cost directly to Across the Divide from the sponsorship money that I raise.

This event is potentially hazardous. You must not enter unless you are medically and physically fit enough to complete the race.

Please type your name in the box below to indicate that you have read and fully agree with ATD EXTREME’s terms and conditions (opens seperately)

I declare that I the participant, am capable to partake in the venture
activities described in the itinerary.

I am happy for my details to be passed onto my chosen charity

Namibia Ultra Marathon 2010

Namibia Marathon 2010

Iceland Laugavegur
Ultra Marathon
July 2009 full - now booking for 2010

Spanish 24hour Ultra Marathon 2010

Coming...Soon Grand Canyon Ultra

Spain, Al Andalus Ultra Trail 11th-18th July 2009

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