Rotary Night Cycle Ride
Rooifontein
7 May 2021

Owing to the weather and track conditions

the Cycle Ride has been postponed until Friday 7 May

Online Ride Entry

 

Please read these instructions and
then complete the form below...

  • Complete the "1st Family Entrant" section, including your contact details.
  • For each additional family member (if any) complete the next "Family Entrant" section. If you wish to enter more than four members of your family, complete a second form.
  • Carefully check your entry.
  • Click on the "Finalise my Ride Entry" button at the end of the form.
  • Each entrant, or each underage entrant's parent or guardian, MUST check the box to agree to the Terms and Conditions.
  • After Finalising your Ride Entry Form and printing the Acknowledgment for your own records, please:-
  • remit you entry fee by EFT as soon as possible to confirm your entry to:-
Bank: Standard
Branch Code: 051001
A/c Name: Rotary Club of Kimberley
A/c Number: 04 006 964 8

Terms and Conditions
By submitting a cycle entry form to participate in the event, I understand and appreciate that there are risks involved and I acknowledge that I participate in the event entirely at my own risk.

I, together with my heirs, executors and administrators hereby release the Rotary Club of Kimberley, its members, and the organisers of the event (including any individual, official, marshal, assistant helper and/or any sponsor) against any and all liability, and I hereby waive my rights to any claims against the aforesaid whatsoever, from whatever cause or nature, howsoever arises, in respect of any loss, damage and/or injury whatsoever (fatal or otherwise) whether same is a result, directly or indirectly, of any negligent act or omission on the part of the Rotary Club of Kimberley, and the organisers of the event, including the persons as set out above, howsoever such loss, damage or harm is caused, nothing at all excepted.

I confirm that I am the parent/legal guardian of the minor children/wards as set out here below, and as such am responsible for their safety whilst they are participating in the above-mentioned event and that the above-mentioned indemnity will also apply to them.


1st Family Entrant
First Name: Last Name:
Cell Phone:
Email:
Male/Female:

Age:

- Name of Parent/Guardian
The Ride I wish to enter:
I, the entrant (or the underage entrant's named parent or guardian named),
agree to the Terms & Conditions above
.

2nd Family Entrant
First Name: Last Name:
Male/Female:

Age:

- Name of Parent/Guardian
The Ride I wish to enter:
I, the entrant (or the underage entrant's named parent or guardian named),
agree to the Terms & Conditions above
.

3rd Family Entrant
First Name: Last Name:
Male/Female:

Age:

- Name of Parent/Guardian
The Ride I wish to enter:
I, the entrant (or the underage entrant's named parent or guardian named),
agree to the Terms & Conditions above
.

4th Family Entrant
First Name: Last Name:
Male/Female:

Age:

- Name of Parent/Guardian
The Ride I wish to enter:
I, the entrant (or the underage entrant's named parent or guardian named),
agree to the Terms & Conditions above
.
Total amount due:


Registrations will only be accepted if ALL required fields have been entered correctly.


1. For information about the Ride, contact:

Corlia van Tonder
Cell:
082 898 3805
Email:
wcvantonder@vodamail.co.za

2. For technical queries about this on-line registration, contact:

Barry Downs
Cell:
083 621 9911
Email:
barry@rotary9370.org.za
The Rotary Club of Kimberley - Night Cycle Ride