of the Oakhurst Insurance Eden Xperience of the Oakhurst Insurance Eden Xperience

Surname: Surname:
First Name: Initials: First Name: Initials:
Address: Address:
Postal Code: Postal Code:
Tel/Cell no: Tel/Cell no:
E-mail: E-mail:
School: Grade / Age: School: Grade / Age:
Emergency Contact Details: Emergency Contact Details:
Full name: Cell no: Relationship: Full name: Cell no: Relationship:
Medical Aid: Aid no: Medical Aid: Aid no:
You have my permission to share my contact details with the main sponsors of the event (please tick ) You have my permission to share my contact details with the main sponsors of the event (please tick )
THE WEARING OF HELMETS IS COMPULSORY! (NO Helmet - NO Ride) THE WEARING OF HELMETS IS COMPULSORY! (NO Helmet - NO Ride)
Please indicate race participation: Please indicate race participation:
Distance Entry Fee
Starting
Time
Distance Entry Fee
Starting
Time
45 KM* R 70-00 08H00 45 KM* R 70-00 08H00
20 KM R 60-00 08H15 20 KM R 60-00 08H15
10 KM R 50-00 08H30 10 KM R 50-00 08H30
1 KM R 20-00 08H45 1 KM R 20-00 08H45
TOTAL PAID TOTAL PAID
Indemnity waiver wrt my participation at the above event: Indemnity waiver wrt my participation at the above event:
Signature of Rider Date Signature of parent or Guardian Signature of Rider Date Signature of parent or Guardian
if under 18 years of age if under 18 years of age
SATURDAY 06 SEPTEMBER 2014 GLENWOOD HOUSE PRIVATE SCHOOL, GEORGE
I agree not to hold CSA, the organisers, officials, marshals, helpers, sponsors, any local authority, any landowner, any employee
of any of the aforementioned, or any person assisting in the organisation or holding of the race liable for any loss, injury or illness,
which I may suffer directly or indirectly as a result of participating in the race, or for any damages to my property or loss of my
property which I may suffer directly as a result of participating in the race. I confirm that this special agreement is entered into for
the benefit of Glenwood House Private School, the sponsors and persons assisting in the organisation and holding of the race
ENTRY FORM
Paid
* CSA Day License R 35-00
ENTRY FORM
I agree not to hold CSA, the organisers, officials, marshals, helpers, sponsors, any local authority, any landowner, any employee
of any of the aforementioned, or any person assisting in the organisation or holding of the race liable for any loss, injury or illness,
which I may suffer directly or indirectly as a result of participating in the race, or for any damages to my property or loss of my
property which I may suffer directly as a result of participating in the race. I confirm that this special agreement is entered into for
the benefit of Glenwood House Private School, the sponsors and persons assisting in the organisation and holding of the race
Paid
SATURDAY 06 SEPTEMBER 2014 GLENWOOD HOUSE PRIVATE SCHOOL, GEORGE
* CSA Day License R 35-00
082 529 8667
RACE NO:
RACE INFO:
M / F
082 529 8667
RACE NO:
RACE INFO:
M / F
BATTLE OF THE BIKES MTB FUN RIDE BATTLE OF THE BIKES MTB FUN RIDE
Registration on the day: 06H30 - 07H30
Pre-Entries: Close Wed. 3 September 2014
Free buffs for the first 50 pre-entries!
Payments: EFT or at any ABSA Bank
Glenwood House School Parents Association
ABSA Branch: 632956
Account Number: 4073737250
Reference: MTB +Surname + Initials
Fax entry form and payment confirmation to
086 684 7400
Or Entry Box at College Bursar's Office
Entry forms also available on:
www.edenxperience.co.za
Medals to the first 100 cyclists completing
each distance
Registration on the day: 06H30 - 07H30
Pre-Entries: Close Wed. 3 September 2014
Free buffs for the first 50 pre-entries!
Payments: EFT or at any ABSA Bank
Glenwood House School Parents Association
ABSA Branch: 632956
Account Number: 4073737250
Reference: MTB +Surname + Initials
Fax entry form and payment confirmation to
086 684 7400
Or Entry Box at College Bursar's Office
Entry forms also available on:
www.edenxperience.co.za
Medals to the first 100 cyclists completing
each distance