MS Ireland - Muck n Splash 2011

Register

Please use the form below to register for MS Muck n Splash. A registration fee of €15 is required with the balance of €60 to be paid before Thursday, 24th March 2011.

All funds raised will go directly to Multiple Sclerosis Ireland will be used to support our community services that support and inform the MS community around the country.

Thanks for taking part!

* denotes a required field

Account details

Title

First name

Last name

Postal Address

Country

Mobile phone number please include your international dialling code
if outside ireland.

Event details

Team / group name if you are running as part of a team
or group insert the team name
why run as a team?

Date of birth

Emergency contact name please provide an emergency contact

Emergency contact number mobile numbers are best

Choose your login details

Email Address (& Username) a copy of your reference number
and payment receipts will be sent
here

Password choose a secure password, must
be at least 5 characters

Re-enter your password

I would like to register for Muck n Splash 2011 in aid of MS Ireland.

I agree to the terms & conditions below

Terms & Conditions

In consideration of the acceptance of my application and the permission to participate as an entrant or competitor in the MS Muck n Splash 2011 event I, hereby state that I am over 18 years of age and that I have conditioned myself to participate in the event(s) that I have chosen.

I, for myself, my heirs, executors, administrators, successors, and assigns hereby release, waive and forever discharge MS Ireland and Quest Events Ltd of and from all claims, demands, damages, costs, expenses, actions and causes of action, whether in law or equity, in respect of death, injury, loss or damage to my person or property howsoever caused, arising or to arise by reason of my participation in the said event, whether as spectator, participant, competitor, or otherwise, whether prior to, during or subsequent to the event, and notwithstanding that same may have been contributed to or occasioned by the negligence of the aforesaid. I further hereby undertake to hold and safe harmless and agree to indemnify all of the aforesaid from and against any and all liability incurred by any or all of them arising as a result of, or in any way connected with my participation in the said event.

Personal information collected by MS Ireland for MS Muck n Splash is used for the purpose of providing me with information about the event or future MS Muck n Splash events or other activity based events. Information may not be shared with other companies or organisations without my consent. Further I hereby grant full permission to any and all of the foregoing to use any photography, video, motion pictures, recordings or any other record of this event and my image for promotional purposes.

I hereby consent to receive medical treatment in the event of my injury, accident and/or illness, during any event.

Payment Method

Pay by Card

Pay by Cheque

Login

Please enter your details below to view your account, donate sponsorship money or see how much you have left to donate before Muck n Splash 2011.