Appendix 1 to the Regulations

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Appendix 1 to the Regulations of the 35 PKO Wrocław Marathon
REPRESENTATION
Acting on my own behalf, I, the below signed:
(name and surname)
holding valid ID card/passport*:
(series and number)
fulfilling the terms & conditions relating to making entries and participation in the sports event
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entitled: ‘35 PKO Wrocław Marathon’, determined in Chapter IV and V of the Regulations of this event, make
the following representations:
1.
2.
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I represent that I have acquainted myself with the Regulations of the 35 PKO Wrocław Marathon and I fully accept their
provisions as well as I undertake to observe them.
I represent that I am in good health condition and upon making hereof, I am not aware of any health contraindications to
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my participation in the 35 PKO Wrocław Marathon.
Moreover, I represent that I participate in the marathon on my own responsibility, being fully aware of the dangers and
risk resulting from the nature of this sports event, which may consist in loss of health or life.
At the same time:
1.
2.
3.
4.
I consent to processing of my personal data in compliance with the Personal Data Protection Act dated of 29 August
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1997 (i.e. Journal of Laws of 2016, item 922), by the Organiser of the 35 PKO Wrocław Marathon, i.e. Młodzieżowe
Centrum Sportu Wrocław (Youth Sport Centre Wrocław), with registered office at al. Ignacego Jana Paderewskiego 35
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in Wrocław (postal code 51-612), for the purposes connected with organisation and conducting of the 35 PKO Wrocław
Marathon.
I consent/I do not consent to processing of my personal data in compliance with the Personal Data Protection Act
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dated of 29 August 1997 (i.e. Journal of Laws of 2016, item 922), by the Organiser of the 35 PKO Wrocław Marathon,
i.e. Młodzieżowe Centrum Sportu Wrocław (Youth Sport Centre Wrocław), for the purposes of sending of information on
future sports events.
I consent/I do not consent* to electronic sending of commercial information by Młodzieżowe Centrum Sportu Wrocław
(Youth Sport Centre Wrocław) with registered office in Wrocław at al. I. J. Paderewskiego 35 (postal code 51-612),
connected
with
information on next organised editions of Wrocław Marathon as well as other sports and
recreational events organised by Młodzieżowe Centrum Sportu Wrocław (Youth Sport Centre Wrocław) in compliance
with the Act on Electronic Service Provision dated of 18 July 2002 (i.e. Journal of Laws of 2016, item 1030, as
amended), in particular art. 10 of the quoted Act, and art. 172 of the Telecommunication Law Act dated of 14 July 2004
(Journal of Laws of 2016, item 1489, as amended).
I consent/I do not consent* to non-payable use of my image through its preparation, recording and distribution by the
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Organiser of the 35 PKO Wrocław Marathon, i.e. Młodzieżowe Centrum Sportu Wrocław (Youth Sport Centre
Wrocław), with registered office at al. Ignacego Jana Paderewskiego 35 in Wrocław (postal code 51-612),
in the meaning of the Act on Copyright and Related Rights dated of 04 February 1994 (i.e. Journal of Laws of 2016, item
666, as amended) and the Civil Code Act dated of 23 April 1964 (i.e. Journal of Laws of 2016, item 380, as amended)
as well as I grant a non-payable license for the use of the recorded image in the following fields of use:
a. recording and multiplication by means of any known technique and dissemination in any form,
b. entering in computer memory and in multimedia network,
c. multiplication of the record of the image,
d. public exhibition, displaying, playing as well as broadcasting and retransmitting and public provision in such a way
that everyone may have access thereto in the place and at the time selected by themselves,
e. insertion and publishing in the press, on the website, posters, leaflets, brochures, presentations, billboards,
f. broadcasting in TV and radio transmissions,
g. provision of the sponsors and official partners or co-organisers with a copy, on which the image has been recorded,
for the purposes of its use for promotion of the sponsor, official partner or co-organiser
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in the context of its participation in organisation of the 35 PKO Wrocław Marathon,
For promotional and statistic purposes connected with dissemination - with the use of mass media - of the information
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on the 35 PKO Wrocław Marathon.
(Place)
(DD/MM/YYYY)
on
(Signature compliant with the one on the ID document)
* delete as appropriate
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