RTC 2019 Entry
Name *
Your answer
Surname *
Your answer
ID Number *
Your answer
E-mail Address *
Your answer
Mobile Number *
Your answer
Alternate Contact Number
Your answer
Hometown *
Your answer
Previously completed FC Events
Your answer
If no previously completed FC events, please specify brief MTB experiences / races completed
Your answer
Medical Aid
Your answer
Medical Aid Number
Your answer
Medical Aid Plan Type *
Next of Kin Name *
Your answer
Next of Kin Contact Number *
Your answer
T-Shirt Size *
Estimated racing strategy (for batching purposes) *
Riding partner(s) (for batching purposes)
Your answer
Special Dietary Requirements *
If "Other" please specify your dietary requirement
Your answer
Printed Maps and Narrative required? (additional cost applicable RTC - R500) *
If Printed Maps and Narrative are required? Please provide a daytime delivery address (couriers)
Your answer
Postcode
Your answer
I am interested in an all-inclusive pre-packaged support station box option including trail food, spares and maps *
I am interested in hearing more about the good work being done by the Freedom Challenge Scholarship Fund *
I would like to include a once-off Freedom Challenge Scholarship Fund Donation with my entry. *
If Yes to the above please confirm amount
Your answer
Other comments
Your answer
Please check following box to confirm *
Required
Please check following box to confirm *
Required
Please check following box to confirm *
Required
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms