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Registration Form
*
Indicates required field
Name
*
First
Last
Cell phone No
*
ID No:
*
Email
*
Date of Birth
*
dd/mm/yyyy
Emergency Contact Full Name
*
Medical Aid
*
Gender
*
Male
Female
Emergency Contact Number
*
Medical Aid Number
*
Tshirt Size
*
XSmall
Small
Medium
Large
Xlarge
XXLarge
N/A
Race details
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73KM Full Challenge (P350) (tshirt for first 100 paid entries)
50KM Lite Challenge (P200)
23KM Fun Ride (P100)
6KM kiddies Ride (free)
Waiver
Waiver
*
Agreed
I agree that No liability whatsoever shall be attached to the organizers, promoting club, sponsor, or any official or member of the promoting club in respect of any injury, loss or damage suffered by me or by reason of the race, however so caused
PAYMENT DETAILS
To complete your registration you can Deposit entry fees to the following account:
Cycle for Life Club
Bank: Stanbic Bank Botswana
Branch: Fairgrounds
Account No: 9060002018387
Please send proof of payment to info@cycle4lifebw.com and use your Name as reference
REFUNDS will be assessed on a case by case basis. NO REFUNDS if you register and don't pitch up on race day
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