INTERFREIGHT 2010 SITEKI/MHLUME BICYCLE RACE

Race Schedule

Distances
20 Kms
35 Kms
60 Kms
ENTRY FORM
PARENT OR GUARDIAN TO SIGN/AGREE IF CYLCIST IS UNDER 18 YEARS OF AGE.
Full Name :
Date of Birth:
Sex: Male:     Female
DISTANCE:  20Kms: 35Kms: 60Kms:

Men Women
Junior (15-18) Junior
Senior (19-29) Senior
Sub Vet (30-39) Sub Vet
Vets (40-49) Vets
Maters (50+) Masters


RACE NUMBER:
CONTACT NO.:
DOCTOR AND NUMBER:
BLOOD GROUP:
EMAIL:
ALLERGIES:
T-SHIRT SIZE: M   L   XL   XXL
Indemnity / waiver

I undertake to participate entirely at my own risk. I agree that I shall have no claim whatsoever against the organizers, officials, marshalls, helpers, sponsors or any local authority or employee of aforementioned parties, for any loss, damage or injuries whatsoever which I may suffer as a result of my participation in this event, including my arrival and departure there from, and any ceremonies as a result of this function, and I accept responsibility for my own health insurance. In the event of my signing this form as a guardian of a minor, I am bound by the above waiver including to the extent to thich he/she is not capable of waiving his/her rights stipulated above.

REMEMBER NO HELMET - NO RIDE

I Agree I Do Not Agree


INFORMATION

Tel/fax: (09268) 404-9609
Email: zoe@adventuresport.co.sz