Samil Karoo Cycling Challenge Online Entry Form - 2019
When: Saturday, 5 October 2019
Where: Steytlerville Showgrounds
For more info go to https://www.facebook.com/KarooCyclingChallenge/

Entry Fees:
MTB 80km - R220
MTB 60km - R200
MTB 35km - R130
MTB 10km - R60
MTB 5km - R30

Trail Run 10km - R60

Registration times:
Friday 4 October - 5-8pm at Steytlerville Showgrounds
Saturday 5 October - 5-6.30am at Steytlerville Showgrounds

Online entries close on Wednesday 2 October 2019
A late entry fee of R40 will be charged for all late entries received after this date.
Title *
First Name *
Your answer
Surname *
Your answer
ID Number *
Please enter your SA ID Number
Your answer
Email Address *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Age as of 31 December this year *
Your answer
Cell phone no. *
Your answer
Name of Medical Aid
Your answer
Medical Aid Number
Your answer
Name of next of kin *
Your answer
Contact number for next of kin *
Your answer
Home Town *
Your answer
Home Province *
Do you have a CSA membership / license?
CSA membership is required for all races longer than 20km. If you don't have a CSA license you will be required to purchase a day license for R35. Visit http://www.cyclingsa.com/membership/ for more info
Next
Never submit passwords through Google Forms.
This form was created inside of Mountain Events. Report Abuse - Terms of Service