Please complete this form to enter the MTB Tour for 2 - 6 July 2017

Please enter rider details below:

Name & Surname:
Name & Surname
Date of birth:
Date of birth
Contact details:
Contact details
Email:
Email address
ID no:
ID Number
Medical Aid Information:
Medical aid information
Emergency Contact Name & Number
Emergency contact details
Allergies/Illnesses
Allergies/Illnesses
Current health
Excellent
Good, but using medication (high/low blood pressure etc.)
Poor (In which case, we would not recommend you enter as a rider, but rather as support)
Current health
Any alternative medical information
Please indicate if you have any medical issues we should know about.
Special Dietary Preferences
Please indicate if you have special dietary requirements, in order for us to cater accordingly.
Payment:
Credit Card
EFT
Use your full name and surname as reference! RICHTERSVELD TOURS, FNB PORT NOLLOTH, ACC. 62133466046, BRANCH 200806 Email proof of payment to: mail@richtersveldtours.co.za
Enter the code below in here: