2017 Rodney Coast Challenge Team Entry Form
Sunday 5th November 2017
Check out "The Labyrinth Corporate Team Challenge" - There's a $5000 digital media package up for grabs! https://www.rcc.org.nz/details/the-labyrinth-corporate-team-challenge/
Entry Fees - includes event t-shirt*
Team of 2 $ 150 (Youth 13-18 $ 130)
Team of 3 $ 195 (Youth 13-18 $ 150)
Team of 4 $ 220 (Youth 13-18 $180)

*Event t-shirts are included in race packs for entries received before 23rd October 2017

Entries with a postal date after 30th October will be deemed to be late entries. Late entry fee $30.00

No refunds after 30th October without medical certificate

Entry category
Team name
Please use business name if entering The Corporate Team Challenge - e.g. : "Dave's Cafe Team 1"
Your answer
TEAM LEADER First name
Your answer
Family name
Your answer
Postal address
Your answer
Post code
Your answer
Phone
Your answer
Email
Your answer
Run Stage First Name
Your answer
Surname
Your answer
Email
Please enter the actual competitors email address, not just the team leaders
Your answer
Road Cycle First Name
Your answer
Surname
Your answer
Email
Please enter the actual competitors email address, not just the team leaders
Your answer
Mountain Bike First Name
Your answer
Surname
Your answer
Email
Please enter the actual competitors email address, not just the team leaders
Your answer
Kayak Stage First Name
Your answer
Surname
Your answer
Email
Please enter the actual competitors email address, not just the team leaders
Your answer
Payment details
Please pay by direct debit to: 12-3139-0048950-01. Please enter team or family name as reference

Entries with a postal date after 30th October will be deemed to be late entries. Late entry fee $30.00

No refunds after 30th October without medical certificate

Entry Fees - includes event t-shirt
Team of 2 $ 150 (Youth 13-18 $ 130)
Team of 3 $ 195 (Youth 13-18 $ 150)
Team of 4 $ 220 (Youth 13-18 $180)

Entries with a postal date after 30th October will be deemed to be late entries. Late entry fee $30.00

No refunds after 30th October without medical certificate

Total Entry fee
Your answer
Event t-shirts
Event t-shirts are included in race packs for entries received before 23rd October 2017. Please indicate sizes required below:
0
1
2
3
4
5
6
7
8
9
XS
S
M
L
XL
XXL
Donation
Direct donation to the Kaukapakapa Scout Group, thanks :-)
Your answer
Total Paid
Please add up Entry fee and Donation amounts
Your answer
Payment Reference or Cheque Number
If paying by direct debit please enter the payment reference you used, or if sending a cheque please enter the cheque number. If paying for multiple teams please feel free to email payment details to info@rcc.org.nz
Your answer
Waiver
On behalf of myself and/or fellow team members, I/We accept full responsibility and /or liability for any damage to myself, equipment, fellow team members and/or third parties resultant from my/our participating in the Rodney Coast Challenge event and I/We waiver all or any claims against the race organisers and/or their staff. I/We also acknowledge I/We understand that at no stage are any roads closed to the General Public and I/We must at all times obey road rules in relation to cyclists or pedestrians. I/We also acknowledge that a charge of $30 will be made for any unreturned or lost race bibs and/or transponders
Signed
Your full name here
Your answer
Submit
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