Kalahari Augrabies Extreme Marathon
South Africa ~ Registration Form 2010
Complete form in block letters, email to nadia@extrememarathons.com or fax to +27 (0)86 609 7755
General Information
First Name: Surname:
Age & Date of Birth: ID/ Passport Number:
Postal Address: 
Telephone Nos. (incl. country code): Mobile:
Work: Home:
Email (print in lock letters):
T-Shirt size: Allergies:
Meal requirements, e.g. vegetarian:
Medical Aid & No.:
Main Member: Telephone No.:
Medical Aid Telephone No.:  
In event of emergency:
Name: Telephone No.:
Email (block letters):
Description of the various packages listed under Pricing Schedule
 

Price in ZAR

Tick Req. Package
Package 1

14,000

  
Package 2

16,000

  
Package 3

17,200

  
Please tick the following
 

I acknowledge that I am aware that the Kalahari Augrabies Extreme Marathon is an extreme and accordingly a potentially dangerous activity. Although stringent safety measures will be in place, the risk of personal accident or injury cannot be completely excluded.  I confirm that I am physically and mentally well and fit and am able to participate in exercise of this nature without undue risk to my health.
 

I hereby undertake and agree to indemnify and hold harmless all land owners, Augrabies Extreme Marathon cc, its’ employees, volunteer helpers, sponsors and agents against any liability and against any/all proceedings, claims, damages, interest, costs, and/or expenses which may result from any accident or injury to myself or my belongings.
 

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.
 

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".
 

I consent to undergoing a pre-race medical examination* and to having a tetanus vaccination as a condition of entry.  I understand that a failure or refusal to do so will disqualify me from participation in the Kalahari Augrabies Extreme Marathon.
 

I confirm that I am aware that a refusal to cooperate with the reasonable instructions of the race doctor or medical personnel to accept medical intervention or to retire from the race will result in my immediate disqualification and will relieve the organizers of any/all responsibility for my wellbeing.
*Medical forms can be printed from the website or emailed as a word document.  The Medical Form must be email or faxed to the organisers by 01 September 2010.
Signature of Competitor:

 
Signature of Parent/legal guardian if under 21:

 
Date:

Place: