First Name:
Surname:
Sex:	Male Female
Date of birth(dd/mm/yyyy):	T-shirt size:  S  M  L  XL  XXL
Postal address:	Code:
Nationality
E-mail:
Tel:	Fax:
Family doctor:	Tel:
	Blood group:    Allergies:
Medical Aid Company:	Membership no.:
Entry category:	Family fun(R50)    Challenge(R100)    Classic(R150)	Junior(up to 18)    Senior(19-29)    Sub Vet (30-39)    Vet(40-49) Masters(50+)
*Club affiliation:	* Only where relevant
If below 18 years of age name of parent/guardian			Wildcard Number
Race entries exclude admission to Mlilwane Wildlife Sanctuary Entries after 26 May 2008 attract a late penalty.

I, hereby declare that I am 18 years of age or older or that I am the parent / legal guardian of the aforementioned minor, I also declare on behalf of myself / minor in my charge that I:
1) Assume all risks of participation in the IMVELO MTB CLASSIC,
2) Absolve and discharge the organisers, officials, marshalls, helpers, sponsors, or any local authority or employee of the aforementioned parties from all claims for loss, damage, injury or death, howsoever caused, arising from participation in the IMVELO MTB CLASSIC,
3) Agree to abide by all competition rules and regulations.