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Vulcaniser 2013

Entry Form

1. Please enter your details

First Name

Last Name

Street Address

City/Town/Area

Post code

Country if not NZ

Email Address

Phone Number

Mobile Phone

2. Do you agree to the Conditions of entry on the previous page? *This question is required.

Yes. I, my family, heirs and executioners of any estate waive, release and discharge the event organiser, Christchurch Singletrack Club, sponsors, land owner and all other parties involved in the event of any liability, claims or damages relating to personal injury, loss or damage of equipment, or any matter arising from the event.

3. Please indicate your course option *This question is required.

4. What is your age on race day 9 March 2013? (So we can put you in the correct category) *This question is required. This question requires a valid number format.

5. Please indicate your gender: *This question is required.

6. Are you a current financial member of the Christchurch Singletrack Club? *This question is required.

7. Please inform us of any medical conditions our medical team need to know about:

8. If you were in a serious accident is there a friend or family member you would like us to notify?

First Name

Last Name

Relationship to you

Home Phone Number

Mobile Phone

9. How much will you be paying for this event? Untimed people can just pay on the day, but filling in the form gives us an idea of numbers to expect *This question is required.

10. How will you pay? *This question is required.

11. If you have a complimentary entry, please enter the code here

12. Do you give us permission to share your email address with our sponsors (specifically Cactus)? *This question is required.

13. *An asterix is to make sure you provide the information! If you have any questions please phone (03) 322 7886 or leave a comment here

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