Name, car registration and mobile
phone number	Emergency contact	Allergies or medical
conditions	

			

TEAM NUMBER:
Rogaining Tasmania
Emergency Contact and Medical Form
Please supply the following information for each team member:
•	Team member name, car registration number and mobile telephone number if one is
carried on the course.
•	Name and telephone number of a person to contact in the event of an emergency.
This person must not be a competitor-
•	Details of any medical conditions or allergies that might be of assistance to first aid
staff in the event of an accident or emergency.
ROUTE PLAN
Please provide a list, in order, of the check points the team intends to visit. You do not have
to stick to route you have specified, it will be used to give the event organisers an indication
of where you might be if a search becomes necessary.