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Entry Options
Event aQuelle Midmar Mile
Race Event 3 - Company Team of 2 UNOFFICIAL
Race Date Sat 9th February 2019

Team Details
Team Name
Team Captain
Preferred Number Collection Point
 

Swimmer 1
International Athlete
ID Number
Date Of Birth
Age
Gender
Name
Surname
Postal Address 1
Postal Address 2
Postal City
Province
Postal Code
Completed Midmar Miles
Home Telephone
Work Telephone
Cell Number
Email
Club
Medical Aid
Medical Aid Number
Special Medical Conditions
 
SSA Reg No

Swimmer 2
International Athlete
ID Number
Date Of Birth
Age
Gender
Name
Surname
Postal Address 1
Postal Address 2
Postal City
Province
Postal Code
Completed Midmar Miles
Home Telephone
Work Telephone
Cell Number
Email
Club
Medical Aid
Medical Aid Number
Special Medical Conditions
 
SSA Reg No

Indemnity
In consideration of the acceptance of my entry, I, for myself, executors, heirs, administrators and assigns do hereby release and discharge Midmar Mile and its sponsors, any and all voluntary groups, all medical personnel, any and all authorities from all claims for injuries, damage and property loss I may suffer caused by negligence of any of them and arriving out of my participation in the event including pre and post race activities. I am physically fit and sufficiently trained to participate in this event and assume all risks for participation. I accept all the rules, conditions and regulations which include terms of payment of entry fee and will comply with them. I also grant my permission to Midmar Mile and it’s authorized agents to use my name, photographs, video tape, broadcasts, telecasts, advertising promotion or other account of this event free of charge.

Payment
Payment Method

Entry Fees
Entry Fee R500-00
Total R500-00


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