Individual Registration Form

Please Fill In The Details Below:

* indicates required.

Race Event:*

Bikes are available
for hire
@ Kes 500 on race day.

Price:
Last Name:*
First Name:*
Email:*
Telephone:*
Age:*
Gender:*
Surburb/ Town:*
County:*
Country:*
Blood Type:*
Emergency Contact Name:*
Emergency Contact Number:*
Do you have a medical condition?*
If "other" please specify:

I have read and agreed with the terms and conditions.

Race Event:*
Price:
Last Name:*
First Name:*
Email:*
Telephone:*
Age:*
Gender:*
Surburb/ Town:*
County:*
Country:*
Blood Type:*
Emergency Contact Name:*
Emergency Contact Number:*
Do you have a medical condition?*
If "other" please specify:

I have read and agreed with the terms and conditions.

Race Event:*

Bikes are available
for hire
@ Kes 500 on race day.

Price:
Last Name:*
First Name:*
Email:*
Telephone:*
Age:*
Gender:*
Surburb/ Town:*
County:*
Country:*
Blood Type:*
Emergency Contact Name:*
Emergency Contact Number:*
Do you have a medical condition?*
If "other" please specify:
Number of Participants:
Participant 1 Name:
Participant 1 Age:
Participant 2 Name:
Participant 2 Age:
Participant 3 Name:
Participant 3 Age:
Participant 4 Name:
Participant 4 Age:

I have read and agreed with the terms and conditions.