Competitor Registration

ENTRY FORM

Entries are limited and are accepted, with full payment of the minimum Race Entry Donation, on a first come first served basis.

Entries close on Saturday 4th February 2017, AFTER WHICH TIME NO ENTRIES WILL BE ACCEPTED.

Entries are limited so early registration and payment is essential to guarantee your place.

Entries will be acknowledged by email.

  • Complete all sections for each rider.
  • You can enter up to 6 riders on this form with a mixture of races.
  • Remember you need at least 4 riders in a single race to make a team.
  • If you do not have a team name state TBC.
  • Age is the age in years on the day of your race in 2017.
    • TEAM NAME NAME 1

      DATE OF BIRTH AGE GENDER

      MOBILE EMAIL

      COUNTRY OF RESIDENCE T SHIRT SIZE

      AMREF MEMBERSHIP NUMBER

      TEAM NAME NAME 2

      DATE OF BIRTH AGE GENDER

      MOBILE EMAIL

      COUNTRY OF RESIDENCE T SHIRT SIZE

      AMREF MEMBERSHIP NUMBER

      TEAM NAME NAME 3

      DATE OF BIRTH AGE GENDER

      MOBILE EMAIL

      COUNTRY OF RESIDENCE T SHIRT SIZE

      AMREF MEMBERSHIP NUMBER

      TEAM NAME NAME 4

      DATE OF BIRTH AGE GENDER

      MOBILE EMAIL

      COUNTRY OF RESIDENCE T SHIRT SIZE

      AMREF MEMBERSHIP NUMBER

      TEAM NAME NAME 5

      DATE OF BIRTH AGE GENDER

      MOBILE EMAIL

      COUNTRY OF RESIDENCE T SHIRT SIZE

      AMREF MEMBERSHIP NUMBER

      TEAM NAME NAME 6

      DATE OF BIRTH AGE GENDER

      MOBILE EMAIL

      COUNTRY OF RESIDENCE T SHIRT SIZE

      AMREF MEMBERSHIP NUMBER

      PLEASE SELECT YOUR METHOD OF PAYMENT

      Trophy for the individual who raises the highest amount in sponsorship

      Disclaimer

      All entrants (parents or guardians in the case of minors) are required to sign a full disclaimer prior to participation in any of The 10to4 events, without which you will not permitted to start. Please download the disclaimer, print and complete it ready to exchange for your race number at final check in.

      Download Disclaimer Form

      Please note that the confirmation email could be in your Spam folder

      If you don't get a confirmation after submitting your form or if you need to make any changes after submitting this form, kindly contact eventmanager@10to4.org.

      I agree to the above terms