10to4 Event registration 2018
Date: 9th - 11th February 2018
Location: Borana Race Village
Contact: +254 718 235 936 or eventmanager@10to4.org

ENTRIES CLOSE: FRIDAY 2nd FEBRUARY 2018.

Email *
Your answer
First Name *
Your answer
Surname *
Your answer
Gender *
Required
Mobile number (please include dialling code if non Kenyan number i.e. +44, +27) *
Your answer
Date of birth *
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DD
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Which race are you entering? *
Required
We highly recommend AMREF Flying Doctor insurance to cover emergency medical evacuation. Without prior cover, emergency medical evacuation can cost over $4000, which must be paid BEFORE treatment or flight. In an emergency, swift action must be taken and if there are issues with payment, this can be life threatening. You can purchase AMREF medical evacuation cover for the event at just 1,000KSh. Please add onto your payment at checkout. AMREF insurance is NOT valid without payment. More information here: http://flydoc.org/ *
AMREF insurance number
Your answer
Medical Insurance Company
Your answer
Health Insurance Policy Number
Your answer
Payment method *
Required
Total payment *
Your answer
Payment transaction reference (if paying by cash, please write CASH) *
Your answer
Nationality *
Your answer
Tshirt size *
Cap size *
Emergency contact name *
Your answer
Emergency contact number (please include dialling code i.e. +44, +27) *
Your answer
Are you an employee or dependent of BATUK? *
Sponsorship target - The 10to4 raises critical funds for the Mount Kenya Trust, a mountain NGO protecting the forest, wildlife, people and water of Mt Kenya. TOP SPONSORSHIP will win a 30 minute Tropic Air helicopter ride over the mountain, to see where all that hard earned money will go! Pledge & raise over 20,000KSh and we will be enter you into a prize draw to win TWO adult flights to Lamu/Malindi or TWO adult flights to Mombasa, courtesy of Fly540. See FUNDRAISE on the website for more information. I pledge to raise:
I have read and fully understand the race rules and agree that failure to follow any of these rules will mean disqualification and/or removal from the event. Race rules are available under ESSENTIAL INFORMATION on the website. *
I agree to sign a disclaimer form on entry to the Tropic Air 10to4 Mountain Bike race. Failure to sign this form will mean disqualification from the event, with no refund. If the participant is under 18, a parent or guardian must sign. *
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