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Grindrod Bank Umngazi Pondo Pedal 2014 Entry Form

Thank you for your interest in the Grindrod Bank Umngazi Pondo Pedal Race.

  1. This event is open to Riders only and is restricted due to available accommodation.
  2. Cost to Enter is: R6 250.00 per person / R12 500.00 per team. ( + CSA 3 day licence at a cost of R100 per person.)
  3. To secure your team's place, your team has 2 working days to make full payment. Team places are only confirmed once full payment is done.
  4. The 66 Team entries will be taken a first come first serve basis and will close as soon as Team places are full.
  5. Refunds – Please see the refund policy on the website.
  6. A significant portion of each entry will be donated to local schools in the Umngazi area.


If you have any questions, please contact The B-Active Team / 031 764 1885 / info@bactive.com

ENTRY FORM

Please fill in your details below by clicking into each text box:

What is the TEAM NAME?    

Team Member 1:

Team Member 2:

ID Number: ID Number:
First Name: First Name:
Surname: Surname:
Gender:
Gender:
Age: Age:
Cell No: Cell No:
Home No: Home No:
Email: Email:
Confirm Email: Confirm Email:
Postal Address: Postal Address:
Province: Province:
Medical Aid: Medical Aid:
Medical Aid No: Medical Aid No:
Emergency Contact Person: Emergency Contact Person:
Emergency Contact No: Emergency Contact No:
Allergies: Allergies:
T-Shirt Size: T-Shirt Size:
TSA/CSA/MTB Licence?: TSA/CSA/MTB Licence?:
Licence No.: Licence No.:

Would you like a 2014 Picture CD posted to you after the 2014 Event ?


Would you like a Limited Edition Grindrod Bank Umngazi Pondo Pedal Cycling Jersey?
Cost will be added to your room account and The Jersey will be available for you at registration.
Would you like a 2014 Picture CD posted to you after the 2014 Event ?


Would you like a Limited Edition Grindrod Bank Umngazi Pondo Pedal Cycling Jersey?
Cost will be added to your room account and The Jersey will be available for you at registration.

TOTAL: R12500.00



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