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Singletrack Fiesta Entry Form 2012

Page One

1. Who are you?

First Name

Last Name

Street Address

City/Town/Area

Postcode

Email Address

Phone Number

Mobile Phone

2. After the emergency services, who would you like us to contact if you have a serious injury?

First Name

Last Name

Phone Number

Mobile Phone

3. Participants from your familyIf you have more than 6 people from your family taking part, send an email to rebekah@singletrack.org.nz with the details of the extra participants.

Space Cell	Name	Age	Gender
Person # 1 *This question is required	Name	Age	Gender
Person # 2	Name	Age	Gender
Person # 3	Name	Age	Gender
Person # 4	Name	Age	Gender
Person # 5	Name	Age	Gender
Person # 6	Name	Age	Gender

4. Which events will you do?

Space Cell	Cross Country Race	Kids Race	Singlespeed	You snooze you lose
Person #1 *This question is required	Cross Country Race	Kids Race	Singlespeed	You snooze you lose
Person #2	Cross Country Race	Kids Race	Singlespeed	You snooze you lose
Person #3	Cross Country Race	Kids Race	Singlespeed	You snooze you lose
Person #4	Cross Country Race	Kids Race	Singlespeed	You snooze you lose
Person #5	Cross Country Race	Kids Race	Singlespeed	You snooze you lose
Person #6	Cross Country Race	Kids Race	Singlespeed	You snooze you lose

5. If you are doing the singlespeed race, please indicate your weight category. M- means Men under 70 kg, M+ means Men 70 kg and over, W- means Women under 55 kg, W+ means Women 55kg and over.

Space Cell	Weight category
Person # 1	Weight category
Person # 2	Weight category
Person # 3	Weight category
Person # 4	Weight category
Person # 5	Weight category
Person # 6	Weight category

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

Entry Fee is:
$25 for Singletrack Club members (additional person in family $15)
$35 for non-members (additional person in family $15)
No cost for kids races but parent must be helping or racing.
You can pay on the day by cash or cheque - no eftpos is available
Because this form is being used for multiple people, we will require you to sign a waiver and release statement when you register on the day.

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