Moore Stephens Night Run – 5km

R40.00

Name
First Last
Do you belong to a running club?*
- Yes
- No
Name of the running club*
Email*
Gender*
Date Of Birth*

YYYY
MM
DD
Cell Number For During Race*
Nationality*
Province*
City/Town*
Residential City/Town
City/Town*
Residential City/Town
Do You Have Medical Aid?*
Medical Aid Name
Medical Aid Number
Indemnity and Waiver*
- Indemnity and Waiver: By ticking this box I do hereby release and discharge the organizers, any and all sponsors, any and all volunteer groups, all medical personnel, any and all local authorities from all claims for injuries, damage or property loss I may suffer caused by negligence of any above mentioned members and arising out of my participation in this event, including pre and post race activities. I am physically fit and sufficiently trained and experienced in this extreme ultra endurance event and assume all risks for such participation. I accept all rules, conditions and regulations that include the payment of the entry fee and will comply with them.