Registration & Rules

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VIC FALLS MTB CHALLENGE, Zimbabwe
TWO MAN TEAM EVENT - 17 - 21 June 2015
REGISTRATION FORM (Please complete in full)

Race & Age Category:

Male
Female
Mixed(Male/Female)

Team Name:

Cyclist #1 Details:

First Names:
Surname:
Sex: Male
Female
Date of Birth:  
Age:
Nationality:
Passport No:
Date of Expiry:  
Date of Issue:  
T-Shirt Size: XS S M L XL XXL XXXL
Contact Telephone No:
Email:
Medical Aid Details
(Zimbabwe Residents Only):
Medical Aid Number:
Travel Insurance Company Name
(All Other Countries) :
Travel Insurance Policy Number
(All Other Countries) :

Emergency contact details

Name:
Tel:

Cyclist #2 Details:

First Names:
Surname:
Sex: Male
Female
Date of Birth:  
Age:
Nationality:
Passport No:
Date of Expiry:  
Date of Issue:  
T-Shirt Size: XS S M L XL XXL XXXL
Contact Telephone No:
Email:
Medical Aid Details
(Zimbabwe Residents Only):
Medical Aid Number:
Travel Insurance Company Name
(All Other Countries) :
Travel Insurance Policy Number
(All Other Countries) :

Emergency contact details

Name:
Tel:
 
Non - Competitors Details
We offer packages for non-competitors, if you are interested, please complete the details below.
Name Surname Contact Tel Email Preferred Hotel
Accept Terms & Conditions :
Accept Indemnity :

This registration is based on the event details stated in the itinerary for the Victoria Falls MTB Challenge. I confirm having read and fully understood and accepted the terms and conditions of this event.  I declare that I am eligible to compete as defined by ZCF rules. In signing this registration application, I hereby indemnify and hold harmless ‘The Organisers’ of this event and their employees and agents from any losses and injuries sustained by me. Furthermore, I confirm that I am competent and/or authorized to sign this registration form.  I further give permission for the free use of my team’s names, voices or pictures (still or moving) to be used in any broadcast, telecast, advertising, promotion or any other form of advertising of this and future events. I further confirm our team members are both fully covered by a current medical insurance policy, of which a copy will be required at check in.