Green Hero

REGISTRATION FORM

EVENT NAME

Choose Event

16th Aug dirt bike fun ride
17th Aug MTB Fun Ride
16th & 17th Aug both rides

FULL Name

AGE

PHYSICAL ADDRESS

CONTACT NUMBER

EMAIL ADDRESS

Medical Aid details

REGISTRATION DETAILS

16th August 2014 - Dirt bike Fun Ride

REGISTRATION: 7AM-8AM

RIDER BRIEFING: 8:30AM

Adult R180 / Kids R70

INDEMNITY FORM OFF ROAD

17th AUGUST 2014 - MTB Fun Ride

REGISTRATION: 7AM-8AM

RIDER BRIEFING: 8:30AM

Adult R100 / Kids R50

INDEMNITY FORM MTB

Complete registration form to secure your spot / Indemnity form can be completed on the day or email / fax together with proof of payment.

email: bugkiller0071@gmail.com or Fax: 0399782068

BANKING DETAILS:

NAME: Fusion Function

BANK: First National Bank

ACC: 62229338084

BR CODE 260225

REF:Please use name as reference then 16 or 17 for day ride example: Joshua 16 or Joshua 17 or 1617 Joshua

DIRECTIONS - NEARBY TUCKERS DAM

From Durban N2 take Ifafa turn off exit 84 turn right and head inland for 2km's to the Old South Coast Road R102 turn left at T-Junction. Drive about 800m and turn right onto D560 then 2km until loading zone parking area.

Green Hero Adventures

REGISTRATION FORM