2022 10to4 Registration 1 Registrants Details2 Race Details3 Fundraising 4 Insurance & Emergency Details5 Other & Waivers Date: 18th to 20th February 2022 Location: Borana Conservancy Contact: 10to4@MountKenyaTrust.org ENTRIES CLOSE: FRIDAY 4TH FEBRUARY 2022 This form is for new registrations only. If you deferred your 2021 entry, DO NOT complete this form - you should have received an email with a link to a different registration page. If you have not received this, please contact the team at 10to4@MountKenyaTrust.org with a copy of the email you sent to tell us you wanted to defer your 2021 entry. In line with current Government guidelines, all participants aged 18 years or over must be fully vaccinated against Covid-19. Please note you cannot save the form and return to it so please ensure that you have decided which event/s you want to take part in before filling out the below. Before you start, make sure you have the following information to hand if you have it: ID/passport number; Covid-19 vaccination reference number/s; AMREF insurance number; medical insurance company and policy number; emergency contact name and phone number.Before you submit your completed form, please make a note of the total amount payable as you'll need this when you make your payment. If registering for someone under 18 please input the child's name as the registrant but include the adults email and mobile number. Name* First Last Email* Mobile Number*Please include dialling code if non Kenyan number i.e. +44, +27Would you be happy for the 10to4 event organisers to include you on a WhatsApp group with other competitors which would then be used to reach you with urgent information regarding event logistics/security etc?*YesNoGender*MaleFemaleNationality*Date of Birth* Which bike race are you entering?*Extreme - KSh 30,000Classic - KSh 24,000Rush - KSh 24,000Slide - KSh 15,000MINI 10to4 - (Kids Races - 2km, 4.5km, 9km, 13.5km)Which MINI 10to4 race are you entering?*2km Mini (children's race for 4-6yrs) - KSh 3,0004.5k Mini (children's race for 6-8yrs) - KSh 3,5009k Mini (children's race for 6-12yrs) - KSh 3,50013.5k Mini (children's race for 9-12yrs) - KSh 3,500Which school do you attend?*What will be the age of the child on the event date (20th February 2022)?*Adult Rider Supporting 'Mini 10to4' CyclistIf you wish to ride with your child in the MINI 10to4 please insert YOUR name below so we can manage numbers.Add another race?*PLEASE NOTE THIS RELATES TO THE COMPETITOR REGISTERED ABOVE, SHOULD YOU WISH TO REGISTER A NEW ENTRANT YOU CAN DO SO AT THE END OF THIS FORMNo thanksExtreme - KSh 30,000Classic - KSh 24,000Rush - KSh 24,000Slide - KSh 15,000MINI 10to4 - (Kids Races - 2km, 4.5km, 9km, 13.5km)Which MINI 10to4 race are you entering?2km Mini (children's race for 4-6yrs) - KSh 3,0004.5k Mini (children's race for 6-8yrs) - KSh 3,5009k Mini (children's race for 6-12yrs) - KSh 3,50013.5k Mini (children's race for 9-12yrs) - KSh 3,500Which school do you attend?*What will be the age of the child on the event date (20th February 2022)?*Adult Rider Supporting 'Mini 10to4' CyclistIf you wish to ride with your child in the MINI 10to4 please insert YOUR name below so we can manage numbers.Would you like to use our bike drop service?*A bike drop service on Friday evening, along with competitor transport to the START line on Day 2 will be offered from Borana Race Village at a cost of KSh 4,500 per rider. See the Bike Drop page on the 10to4.org website for more details. Please note if you don’t use our Bike Drop service you will need to find your own way up to the START line at 10,000ft. If necessary you can add this service at a later date, though places are limited.YesNoMaybe – I will confirm by 4 February 2022Bike Drop Price: Kshs 4,500 Would you like to camp at Borana Race Village?*Part of the magical experience of the 10to4 is getting to camp on Borana Conservancy at Race Village. Should you wish to take up this opportunity there will be a camping charge of KSh 1,500 per person (kids under 12 camp for free). If you are unsure yet your accommodation plans you have until 4th February to confirm your camping arrangements. Email 10to4@MountKenyaTrust.org for further details.YesNoMaybe - I will confirm by 4th February 2022How many people (12+) would you like to book camping for?*Camping fees Price: Kshs 1,500 Fundraising Target*The 10to4 raises critical funds for the Mount Kenya Trust, a mountain NGO protecting the forest, wildlife, people and water of Mt Kenya. To be able to secure your place in the 10to4 event each participant must pay an entry fee (as detailed above per individual race), however, this doesn’t mean you have to stop there with your fundraising. TOP SPONSORSHIP will win a 30 minute Tropic Air helicopter ride over the mountain, to see where all that hard-earned money will go! For every KSh 2,000 raised above the entry fee you will be entered into a prize draw to win some great prizes. See FUNDRAISING on the website for more information and top tips on how to get fundraising. I pledge to raise:KSh 5,000KSh 10,000KSh 20,000+Offset your Carbon Emissions*Would you like to offset the carbon footprint associated with your travel to and from the event? Mount Kenya Trust is currently working hard to plant 15,000 trees at the Upper Imenti Forest in the north-eastern part of Mt Kenya. We want to replace the invasive and destructive Lantana camara bush with a lush indigenous forest of seedlings whilst providing income for local community members through the project clearing and planting. Each tree costs Ksh 100 to plant and each participant shall also receive an e-certificate indicating the number of trees they have adopted.Yes, please plant 10 trees on my behalf for Ksh 1,000Yes, please plant 20 trees on my behalf for Ksh 2,000No thank you I don't want to offset my carbon footprint Covid-19 vaccination detailsPlease give the vaccine type, date administered and batch number for both doses as found on your Covid-19 Vaccination Certificate. If you are not yet fully vaccinated, please ensure that you have had both doses at least 14 days before the Event. AMREF*We highly recommend AMREF Flying Doctor insurance to cover emergency medical evacuation. Without prior cover, emergency medical evacuation can cost over $4000, which must be paid BEFORE treatment or flight. In an emergency, swift action must be taken and if there are issues with payment, this can be life threatening. You can purchase AMREF medical evacuation cover for the event at just KSh 1,600. If selected below it will be added onto your payment at checkout. AMREF insurance is NOT valid without payment. More information here: http://flydoc.org/ Yes - I already have valid AMREF insuranceI would like to purchase AMREF insurance @ 1,600KSh to cover the eventI DO NOT have AMREF insurance and am aware that in the case of a medical evacuation, I will pay the upfront costs of any medical care or flight.ID / Passport NumberAMREF Insurance Number*Do you have Medical Insurance?*YesNoMedical Insurance CompanyHealth Insurance Policy NumberEmergency Contact Name*Emergency Contact Phone Number*Please include dialling code if non Kenyan number i.e. +44, +27 Are you an employee or dependant of BATUK?*YesNoT-Shirt Size*ChildAdult (Unisex)T-Shirt Size (Child)*4 yrs (Chest size- 27 inches)6 yrs (Chest size- 29 inches)8 yrs (Chest size- 31 inches)10 yrs (Chest size- 33 inches)12 yrs (Chest size- 35 inches)T-Shirt Size (Adult Unisex)*XS (Chest size- 36 inches)S (Chest size- 38 inches)M (Chest size- 40 inches)L (Chest size- 42 inches)XL (Chest size- 44 inches)XXL (Chest size- 46 inches)Race Rules*You can find details of the race rules on the 10to4 website - www/10to4.org/race-rules I have read and fully understand the race rules and agree that failure to follow any of these rules will mean disqualification and/or removal from the event. Acknowledgement and Waiver*You can find details of the disclaimer on the Terms and Conditions page of the 10to4.org website. I agree to sign a disclaimer form prior to entry to the Tropic Air 10to4 Mountain Bike race. Failure to sign this form will mean disqualification from the event, with no refund. If the participant is under 18, a parent or guardian must sign. TotalPlease make a note of the total amount as you'll need this figure when you make your payment. Kshs 0 This iframe contains the logic required to handle Ajax powered Gravity Forms.