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Please fill out form, then Print and Post it with your payment to  RTC100, C/- 14 Joe Brown Ave, Mosgiel, 9024
or you can enter here on this EMAIL

Class you wish to enter 
If Team, team name please
Total Riders
Your FIRST Name
Your Surname
Postal Address
Town
Phone number
Email address
Rider #2
Rider #3
Rider #4


 

Please advise how you are are paying your entry, If Online, please use your Surname as Identifier
Bank Acc # 03 1725 0111933 002

Cycling Otago 2009 Rail Trail Challenge event - DISCLAIMER
I understand that participation in the 2011 RTC100 event involves a risk of injury or death. I confirm that I and my team are physically fit and suffer no medical condition, disability or lack of skill which would render me/us unsuitable for this event. When the route is crossing private land, I release and indemnify landowners from any liability, claims, loss or damages which may arise, including any liability under the Health Safety in Employment Act 1992. I personally accept all risk for myself and my team and release the organisers and all other parties involved in the event of any liability, claims, damages or expenses arising from my./our team involvement in the RTC100 event. Important: When riding on public roads, I and my team, agree to abide by the road rules always. I will abide Marshalls instructions.