Which event are you apply for?
If you know the date of the event, please select.
If Corporate Challenge Entry or Pub Challenge Entry - name of organisation

Please complete the following section carefully:

Important Note

  1. All team members must be over 16 years of age and the team leader 18 years of age or above.
  2. Exceptionally we will allow up to 2 team members between 14 and 16 years of age if in a team with one of their parents.
  3. All persons under 18 years MUST have a parental consent form signed by a parent/guardian. (Bottom of form)
  4. Teams must consist of between 4 – 6 members
  5. All walkers participate at their own risk
  6. Please advise organisers of any team member changes asap
  7. Entrance fee is £12 per person before 31/12/2018 and £15 per person after this date
Total fee enclosed – Please send one cheque made payable to Ilfracombe Rotary Club Trust Fund £

Each team member will receive a souvenir booklet and team photograph.

The teams that are adjudged to have raised the most sponsorship money will be allowed to nominate a charity or good cause to receive £500, £300 or £150 from proceeds raised.

The business or organisation raising the most sponsorship from their teams will be allowed to nominate a charity or good cause to receive £500 from the proceeds raised.

The pub team raising the most sponsorship will be allowed to nominate a charity or good cause to receive £500 from the proceeds raised.

The Rotary Clubs of Ilfracombe must reserve to the right to approve the charity or good cause chosen. The winning team will be asked to present the cheque to the approved charity at the Startrek Presentation and Prize Giving event.

Brief Description of the work that they do.
Have you entered before and when? Please list YEARS.

Please Help Us

Thank you for entering your team. It would be helpful if you could tell us how you are aware of our event and reason for taking part:

Medical Information

Do you or any of your team suffer from any medical condition? If so, are they likely to require medical treatment? Please state treatment required. If not answer NO :

Parental Consent

I have read the Startrek information sheet and agree to the above named participating in the event described.

I acknowledge their need for care and responsible behaviour when undertaking the course.

Medical Information

Has your son/daughter received a tetanus in the last five years?
Does your son/daughter suffer from any condition requiring medical treatment, including medication?

Declaration

I agree to my son/daughter receiving emergency treatment including anaesthetic, as considered necessary by medical authorities present. I understand the extent and limitation of the insurance cover provided.

Startrek Challenge

Startrek Challenge Is organised by the Startrek Committee, which consist of members of the Ilfracombe Rotary Club, Ilfracombe Compass Rotary Club and Volunteers. The event is run for the sole purpose of raising funds for our main beneficiaries: North Devon Hospice, The Children’s Hospice South West and also other local good causes. Our expectations would be that walkers would reach an absolute minimum of £50 sponsorship each.

I Confirm that my team have agreed to the conditions set by organisers.

Information packs will be issued once an entry has been accepted. Generally only 100 teams can be accepted in predetermined categories. There is also a limit to the number of ‘Half Trek’ Teams.

The organisers decision not to accept teams will be final, in which case the entry fee will be returned.

The Rotary Club of Ilfracombe Trust Fund is a Registered Charity – No 1037348

Payment

Please send your cheque made payable to Rotary Club of Ilfracombe Trust Fund for your fee or credit our account Sort code 30-94-52 account number 00318046 quoting your team name:-

Thomas Westcott, Chartered Accountants, 96 High Street, Ilfracombe, EX34 9NH
Tel: 01271 863662/862458 Fax: 01271 865617

The Startrek Committee would like to thank you and your team for your application and look forward to meeting you all at the event.