Enter Online K3 – Breede River Canoe Marathon

2019 BREEDE RIVER CANOE MARATHON ONLINE K3 ENTRY FORM
This entry form can be completed online and submitted electronically.
Entry confirms that you have read, and will abide by the race rules, which can be found here

Boat Number

SpecialCategory

CSA Number

Paddler 1 Surname

First Name

Initials

ID Number

Date of Birth

Click on year and then again to select decade, then select year, month and day.

Club

Province

Gender

Cellphone

Shirt size

Emergency Contact

Contact in case of an Emergency

Emergency Contact Number

Emergency Contact's cellphone number

CSA Number

Surname

First Name

Initials

ID Number

Date of Birth

Click on year and then again to select decade, then select year, month and day.

Club

Province

Gender

Cellphone

Shirt size

Emergency Contact

Contact in case of an Emergency

Emergency Contact Number

Emergtency Contact's cellphone number

CSA Number

Surname

First Name

Initials

ID Number

Date of Birth

Click on year and then again to select decade, then select year, month and day.

Club

Province

Gender

Cellphone

Shirt Size

Emergency Contact

Contact in case of an Emergency

Emergency Contact Number

Emergency Contact's cellphone number

Entry Fee

Senior R850 Under 23 R750 Junior R700

Entry Fee

Senior R850 Under 23 R750 Junior R700

Entry Fee

Senior R850 Under 23 R750 Junior R700

Total

Total: R

PADDLER ONE INDEMNITY : By virtue of the submission of my entry I warrant that I have signed the indemnity/safety declarations of CSA. I undertake to abide by the rules of the race and accept that I will forfeit my prizemoney or risk disqualification should I transgress any rules laid down by CSA, WCCU and the organisers of the event.

I accept

PADDLER ONE INDEMNITY - MINORS : For minors under 18 years: I, the parent or legal guardian of the person mentioned above warrant that I have signed the indemnity/safety declaration of CSA permitting him/her to participate at his/her own risk and responsibility.

Not applicable

I accept

PADDLER TWO INDEMNITY : By virtue of the submission of my entry I warrant that I have signed the indemnity/safety declarations of CSA. I undertake to abide by the rules of the race and accept that I will forfeit my prizemoney or risk disqualification should I transgress any rules laid down by CSA, WCCU and the organisers of the event.

I accept

PADDLER TWO INDEMNITY - MINORS : For minors under 18 years: I, the parent or legal guardian of the person mentioned above warrant that I have signed the indemnity/safety declaration of CSA permitting him/her to participate at his/her own risk and responsibility.

Not Applicable

I accept

PADDLER THREE INDEMNITY : By virtue of the submission of my entry I warrant that I have signed the indemnity/safety declarations of CSA. I undertake to abide by the rules of the race and accept that I will forfeit my prizemoney or risk disqualification should I transgress any rules laid down by CSA, WCCU and the organisers of the event.

I accept

PADDLER THREE INDEMNITY - MINORS : For minors under 18 years: I, the parent or legal guardian of the person mentioned above warrant that I have signed the indemnity/safety declaration of CSA permitting him/her to participate at his/her own risk and responsibility.

Not Applicable

I accept

Monies can be deposited directly into the MILNERTON CANOE CLUB’S Breede account – either manually or electronically:
Milnerton Canoe Club, Nedbank Milnerton, Branch Code: 109309, Account Number: 1093074590
NB: PLEASE ENTER YOUR CSA REGISTRATION NUMBER(S) AS REFERENCE. Please use your race number as your reference. You do not need to submit proof of payment, but please retain it for submission if requested.