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Addo Elephant Trail Runs 2009 ~ Registration Form |
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COMPLETE FORM IN BLOCK LETTERS, SCAN AND EMAIL TO nadia@extrememarthons.com OR FAX TO 086 609 7755 |
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(SHOULD YOU HAVE ANY QUERIES, KINDLY CONTACT US BY EMAIL, FAX OR TELEPHONE) |
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Last Name: First Names: |
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Male/Female: Age & Date of Birth: |
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Nationality: ID/Passport No: |
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Postal Address: |
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Country: |
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Tel. Nos.(insert country code): Home: |
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Work: Mobile: Mobile: |
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Email: |
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Next of Kin (in event of emergency): |
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Telephone No (insert country and code): |
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T-Shirt size: Socks size: |
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South African Participants |
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Medical Aid and No: |
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My Medical Aid covers me for Extreme Sports of this nature. Yes No |
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International Participants - Travel Insurance Details |
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Please reserve the following on my behalf: |
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R950.00 ~ Addo Elephant 100Miler Trail (Limited to 100 Participants) |
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R550.00 ~ Addo Elephant 50Miler Trail (Limited to 200 Participants) |
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R350.00 ~ Addo Elephant 25Miler Trail (Limited to 200 Participants) |
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Registration is based on the event details stated in the itinerary for the Addo Elephant Trail Runs 2009. |
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(Please tick the following) |
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I am in good physical and mental health, and fully realize the risks involved in participating in an extreme event such as the Addo Elephant Trail Runs. |
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In submitting this booking application, I hereby indemnify and hold harmless Augrabies Extreme Marathon cc, its’ employees, volunteer helpers, sponsors and agents from all losses and injuries sustained by me. |
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I grant my permission to use my name, race information and photographs, video tapes, broadcasts and telecasts in which I may appear, free of charge. |
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If my Medical Aid/Insurance does not cover me for this type of event, I fully accept that ALL evacuation/hospitalization/medical costs will be for my own expense as laid out in the Conditions of Contract. |
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I confirm having read and fully understood the Rules and accepted the “Terms and Conditions” of this contract as more fully set out in "Conditions of Contract". |
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Signature of Competitor: |
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Signature of Parent/legal guardian if under 21: |
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Date: Place: |
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