Cycling 4 CF Entry Form 2018
Details to enter Telkom 94.7 Cycle Challenge
SURNAME *
Your answer
FIRST NAME *
Your answer
CYCLING PACKAGE *
CYCLING SHIRT REQUIRED? *
CHOCE OF MEMENTO *
TYPE OF IDENTIFICATION *
ID NUMBER *
Your answer
DATE OF BIRTH *
MM
/
DD
/
YYYY
GENDER *
PROVINCE *
Your answer
SUBURB *
Your answer
NICKNAME (max 8 characters, must register before 31 July if you want it on your race number)
Your answer
EMAIL *
Your answer
WORK NUMBER
Your answer
CELL NUMBER *
Your answer
MEDICAL AID NAME *
Your answer
MEDICAL AID NUMBER *
Your answer
MAIN MEMBER NAME *
Your answer
EMERGENCY CONTACT RELATIONSHIP *
Your answer
EMERGENCY CONTACT NAME *
Your answer
EMERGENCY CONTACT CELL NO *
Your answer
MED CONDITIONS/ALLERGIES
Your answer
MEDICAL DISABILITIES
Your answer
MEDICATION
Your answer
TIMING CHIP REQUIRED @ R140 extra charge? Every entrant must have a Racetec timing chip. Please add to your package amount before you pay. *
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