WILDLIFE & ENVIRONMENT ZIMBABWE PUMPING LEGS FOR WATER 2018
To participate in this ride cyclist must:
a) Complete & submit this registration form,
b) Pay an entry fee of USD $200,
c) Seek additional sponsorship and
d) Receive confirmation of participation from the Ride Secretary.

Entry fees should be deposited into the WEZ bank account:
Wildlife & Environment Zimbabwe,
Barclays Bank Main St. Branch
Acc. No. - 2307-2223098
Sort Code - 2322
Swift Code - BARCZWHX

OR deposits may be handed in at The Battery Centre, 11th Avenue between G Silundika and Fife Street, Bulawayo.

Closing date for entries is 31 May 2018. Numbers may have to be limited. See Rules & Conditions for further details. This is NOT A RACE. The ride is open to individuals and teams of 2 people, however relay teams may only change over at designated points. Each member of a relay team will be required to submit an entry form & pay the entry fee of USD $200. Riders under the age of 10 will not be accepted. Children under the age of 16 must ride with a parent. You will be riding in a wildlife area, all rules must be strictly adhered to. Helmets must be worn.

Date of Birth *
MM
/
DD
/
YYYY
Age if Under 18
Your Full Name *
Your answer
Gender *
Address *
Your answer
Your Email
Your answer
Residence *
Required
Phone Number *
Your answer
Cell Number *
Your answer
Doctors Name *
Your answer
Doctors Email Address *
Your answer
Doctors Number *
Your answer
Medical Details *
Only basic first aid facilities will be available during the ride.NOTE: If you have any medical or first aid training and would be prepared to help in event of an emergency please give details.
Your answer
Do you have Medical Aid *
If Yes
Please supply details Medical Aid Name: Medical Aid Number:
Your answer
Name of Person to be contacted in case of Emergency *
Your answer
Relationship to you *
Your answer
Contact Details for Emergency Contact *
Your answer
Riding Shirt Size *
T-Shirt Size *
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