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                                             ENTRY FORM 2014 

                                                                                                                 

SURNAME:___________________________AGE:________________

 

FIRST NAMES:_____________________________________________

 

I.D. NUMBER: _____________________________________________

 

RACE ENTERED: __________________________________________

 

PACKAGE OPTION ________________________________________

 

TEL (W): ____________________ (H): __________________________

 

CELL: ____________________________________________________

 

E-Mail: ____________________________________________________

 

CLUB:_____________________________________________________

 

PROVINCE: LICENCE NO: ____________________________________

 

WINDBREAKER SIZE: S:_____ M:_____L:_____XL:_____XXL:______

 

 

Release and Waiver.

 

In consideration of the acceptance of my entry, I myself, my executors, heirs, administrators and    assigns, do hereby release myself and discharge any and all sponsors, any and all organizers, any and all volunteer groups, all medical personnel, any and all local authorities from any claims for injury, damage or property loss I may suffer caused by any negligence arising out of my participation in this event including Pre and Post race activities.

I am physically fit and sufficiently trained to participate in these events and assume all risk for such participation. I accept all rules, conditions, which include the terms of payment of the entry fee and

comply with them.

 

I hereby declare the foregoing particulars to be true in every respect.

 

Signature of Entrant: _______________________ Date: _____________

 

 

 

 

 



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