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Entry Form 2013
Entry Form 2013
PAYMENT (tick applicable box) EFT CASH CHQ TOTAL: Payment Reference # (First 6 digits of ID barcode): SHOULD YOU FAIL TO USE THE PAYMENT REFERENCE NUMBER - WE WILL NOT PROCESS YOUR ENTRY PAYMENT DETAILS: L Robbertze, Capitec Bank 470 010; Acc # 127 286 3016 (Savings Account). Please fax/email proof of payment together with your entry form to 086 725 0270 or pjfunrun@gmail.com. Participants may pre-enter until 10/09/2013 online via e-mail pjfunrun@gmail.com, fax 086 725 0270 or the Pride & Joy School Post Box situated at 85 Helderberg College Road, Somerset West. RELEASE AND WAIVER I agree not to hold Pride & Joy Professional Child Care Academy or any sponsors, persons assisting in the organisation of holding the race liable for injury or illness, which I may suffer directly or indirectly as a result of participating in the race or for any damage to my property or loss of my property which I may suffer directly or indirectly as a result of participating in the race. I confirm that this Special Agreement is entered into for the benefitf the Pride & Joy Professional Child Care Academy event, the sponsors and the persons assisting in the organisation or the event.
Date:
WATERSTONE VILLAGE
ENCHANTRI
JC Losla
FOR M O RE INF O RM AT I O N & R EGISTRATION:
& FRIENDS