Imvelo MTB Classic Entry Form
Please complete this this form fully to ensure accurate data capturing and results
PERSONAL INFORMATION
Name
Your answer
Surname
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
ID Number
Your answer
Country of Residence
CONTACT INFORMATION
Telephone Number
Your answer
Cellphone Number
Your answer
Email Address
Your answer
EMERGENCY INFORMATION
Medical Aid
Your answer
Membership Number
Your answer
Main Member
Your answer
ENTRY INFORMATION
PLEASE NOTE: Only children under the age of 12 are eligible for prizes in the 12.5km Hoglet. The youngest category in the 64km Classic is Junior so all participants under the age of 18 will compete in this category.
Please tick appropriate box
Hoglet 12.5km R195.00
Family 22km R220.00
Challenge 35km R320.00
Classic 60km R395.00
Hoglets <12
Sub Junior 12 - 14
Youth 15 -16
Junior 17 - 19
Senior 19 - 29
Sub Vet 30 - 39
Vet 40 - 49
Master 50 - 59
Grand Master 60+
T-Shirt Size
Cycling License Number
Your answer
I, hereby declare that I am 18 years or older or that I am the parent / legal guardian of the aforementioned minor, I also declare on behalf of myself / minor in my charge, that I: Assume all risk of participation in the IMVELO MTB CLASSIC; Absolve and discharge the organisers, officials, marshalls, helpers, sponsors or any local authority or employee of the afore- mentioned parties from all claims for loss, damage, injury or death, howsoever caused, arising from participation in the IMVELO MTB CLASSIC; Agree to abide by all rules and regulations of the race and of Mlilwane Wildlife Sanctuary.
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