2010 DRAK CHALLENGE K2 ENTRY FORM This entry form can be completed online and submitted electronically. Proof of payment must be emailed or faxed to confirm your entry. Entry confirms that you have read, and will abide by the race rules, which can be found here BOAT NUMBER Class:K2 Paddler One K2 only - Paddler Two CSA Registration Number : CSA Registration Number : Surname: Surname: Initials: Initials: First Name: First Name: ID Number: ID Number: Club: Club: Date of birth : Date of birth : Sex: Male Female Sex: Male Female Category: Junior Senior Sub-Veteran Veteran Sub-Master Master Sub-Grand Master Grand Master Category: Junior Senior Sub-Veteran Veteran Sub-Master Master Sub-Grand Master Grand Master Postal Address: Postal Address: Postal Code: Postal Code: Tel - work: Tel - work: Tel - home: Tel - home: Tel - fax : Tel - fax : Tel - cell : Tel - cell : e-mail : e-mail : T-Shirt size: Small Medium Large X-Large XX-Large T-Shirt size: Small Medium Large X-Large XX-Large Entry Late entry Senior R420,00 Late entry Junior R280,00 Drak Batch Late entry Senior R720 Drak Batch Late entry Junior R580 Entry Late entry Senior R420,00 Late entry Junior R280,00 Drak Batch Late entry Senior R720 Drak Batch Late entry Junior R580 Total R Have you completed 10 or more Drak Challenges? Yes No Have you completed 10 or more Drak Challenges? Yes No INDEMNITY : We, the undersigned, hereby declare that we are sufficiently competent to take part in the Drak Challenge, assume all risks of participation in the Drak Challenge, release and discharge the organisers and all their assistants as well as the sponsors from all claims arising for loss, damage, injury or death we may suffer arising from our participation in the race, and agree to abide by all the race and CSA rules, which we have read and understood. I further certify that the information above is correct . I confirmed that I have read the rules, and terms of the indemnity, and will abide by these. Paddler One: Paddler Two: Entry Cost: Senior Paddlers - R320 Junior Paddlers - R180 Closing Date: 19 February 2010 - 6pm Late entry closing: 24 February 2010 - an additional charge of R100 per paddler. Drak (E) batch: Additional R300 per paddler. Payment Methods: Phone enquiries to (033) 7011067 Fax a copy of bank deposit to 033 7011 067, or email proof of EFT transfer to entries@drak.co.za. NB Use CSA National Reg No and name as depositors reference. Online registration via website. Bank Account Details: Canyon Kayak Club, FNB Underberg, Code 221025, Acc No: 52550026854 To submit your survey response entry by email click here > > >
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To submit your survey response entry by email click here > > >
