Big Walk Entry Form

Page 1

Enter at any one of these Totalsports stores. Amanzimtoti: Shop G11,The Galleria, c/o Openheimer RD, Umbogintwini, Amanzimtoti - 031 9221039 Bridge City: Shop U18,Bridge City Mall, Phoenix Industrial, KWA Mashu, Durban - 031 5302116 Chatsworth: Shop 59/60 Chatsworth Centre, 17 Joy Hurst Road - 031 401 9030 Empangeni: Shop 325, Sanlam Centre, Maxwell Street, Empangeni - 035 792 4018/9 Gateway: Shop G296A, Gateway Shopping Centre, Umhlanga Rocks Drive, Durban - 031 566 1680/3816 Inkwazi Mall Richards Bay: Shop U45, Boardwalk, Inkwazi Mall, Krugerrand Rd, Richards Bay - 035 9019041/2 Ladysmith: Murchison Mall, Unit 712, 220 Murchin Street, Ladysmith - 036 631 4372 La Lucia: Shop 120, La Lucia Mall, William Campbell Drive, La Lucia - 031 562 7142/3 Midlands Mall: Shop 220, Liberty Midlands Mall, Pietermaritzburg - 033 355 1880/78 Musgrave: Shop 302/303, Musgrave Centre, Musgrave Road, Durban - 031 202 1446 Newcastle: Shop 3, Lot 444/447, Scott Street, Newcastle - 034 315 3342 Pietermaritzburg: 202 Church Street, Pietermaritzburg - 033 394 7911 Pinetown: Shop 216, Sanlam Centre, Kings Road, Pinetown - 031 701 3296/3213 Shelley Beach: Shop 86, Shelley Centre, Marine Drive, Shelley Beach - 039 315 9130/4 West Street: 395 West Street, Durban - 031 301 3154/5 Westville Pavilion: Shop 209, The Pavilion,Spine Street, Westville - 031 275 6062/3 Westwood Mall: U76, Westwood Shopping Centre, Jan Smuts Ave, Garden Park, Westville - 031 279 9737/40

Show us your moves. 22 May 2011. Choose from the 5km, 10km, 15km or 20km route. Entries close on 6 May. Complete this entry form or visit www.ecr.co.za to enter now.


REF No.:

REF No.:

For Office Use Only.

DISCOVERY EAST COAST RADIO BIG WALK - 22 May 2011 PLEASE NOTE: ALL GROUP ENTRIES (20 OR MORE) CAN ONLY BE MADE VIA THE EVENTS OFFICE Please email bigwalk@ecr.co.za or call 083 910 3825 for assistance.

Non-Timed Distances Timed Distance

5km

N/A

0

R50

R35

10km

N/A

R20

R55

R40

15km

N/A

R25

R65

R40

20km

16 yrs

R25

R65

ENTRY FORM (PHOTOCOPIES ACCEPTABLE) Please complete all details – those marked with * are compulsory. Entries without ID Number/D.O.B. will not be accepted.

*Date Of Birth: (DD/MM/YYYY) Age: *ID Number: OR *Passport Number: *Athletics Licence Number: Club: Province: *Surname: *First Names: *Address Line 1: *Address Line 2: *Address Line 3: Postal Code: Company Name: Dept. in Company: (if applicable) Telephone (H): Telephone (W): *Cell Number: *Email Address: *T-shirt size: Small Medium Large XLarge Ages: 5-6 7-8 9-10 Please tick your route: Non - Timed Walks: Timed Walk:

DISTANCE 5 km 10 km 15 km 20 km

18 - 39 (senior)

RSA Citizen: Yes

No

REGISTER Once you have entered, you will be required to bring along your reference number confirmation to collect all of your goodies at Registration. See details below: Remember • T-shirt Sizes are guaranteed (as requested) to those walkers who enter before Friday, 22 April 2011. The T-Shirt sizes of late entrants i.e 23 April 2011 and later will be subject to availability and issued on a first come – first served basis at registration. • Permanent licensed walkers must bring along to registration proof of licence number in order to be refunded. VENUE:

DATES AND TIMES: Thursday, 19 May 2011: Friday, 20 May 2011: Saturday, 21 May 2011:

10h00 – 19h00 10h00 – 19h00 10h00 – 14h00

Distance

5KM

10KM

15KM

20KM

Start Time

9.45

9.00

7.45

7.00

Start Area

uShaka Marine World

uShaka Marine World

uShaka Marine World

uShaka Marine World

HOST CLUB:

Savages Athletics Club.

FINISH AREA:

George Campbell School of Technology.

FIRST AID:

Will be available on route.

TIME LIMIT:

Walkers must complete the course distance they entered before 12h00. Walkers on the road after 12h00 will be deemed to have retired. (Sweep Vehicles, will collect all walkers who are still en route at this time).

REFRESHMENTS:

Each participant will receive a 500ml bottle of aQuelle water at the finish, water sachets will be available (at regular intervals) at refreshment points along the route. The locations of these points will be advised in your walk packs.

XXLarge

3XL

START CARDS:

Arrive at the start no later than 45 minutes before start time and hand your card to one of the officials at the start gate.

TIMING:

Each participant must wear a race number on the front and back, AND must ensure that they are wearing the race number that was allocated to them! NO RACE NUMBER – NO TIME AND NO FINISH CERTIFICATE!

SEEDING:

Club athletes will be allowed to start at the front if they are wearing club colours.

CERTIFICATES:

Certificates will only be issued to entrants on the 20km route.

11-12

50 - 59 (master)

CHAMPIONS ROOM, GREYVILLE RACECOURSE

20KM WALKERS, PLEASE NOTE:

DISCOVERY VITALITY POINTS

uShaka Marine World / George Campbell School of Technology uShaka Marine World / George Campbell School of Technology uShaka Marine World / George Campbell School of Technology uShaka Marine World / George Campbell School of Technology

3000 Vitality fitness points 3000 Vitality fitness points 5000 Vitality fitness points 5000 Vitality fitness points

60 - 69 (grand master)

RULES OF ENTRY 1. 2. 3. 4. 5. 6.

70+ (grand grand master)

Are you a Discovery Vitality member (make sure you tick this box if you are a Vitality member to ensure that you receive your points): Yes No Would you like to know more about Discovery products and services, which include: cash back on premiums, lifestyle, leisure and travel benefits. Yes

No

ENTRY PAYMENT METHODS

Online - Credit cards At Totalsports stores - cash and all cards accepted (incl. in-store cards)

DECLARATION

I have read the Rules of Entry, including the waiver. I shall walk entirely at my own risk and declare that all the above information is correct. I accept that any irregularities in the entry form may result in my entry not being accepted.

Enter before Friday, 22 April: To stand a chance to be one of 20 WINNERS to walk away with either aQuelle product for a year or Totalsports vouchers valued at R1000 each . To guarantee your t-shirt SIZE. Note: the t-shirt SIZES of all late entrants i.e those entering 23 April and later will be subject to availability.

PUBLIC TRANSPORT: This service is available to all walkers on the day at NO cost.

Bus Service: This service is available to all walkers on the day at NO cost. To assist with effective planning on the day, please indicate if you will be using this service on the day. Yes No

Signature of entrant:

• • •

CATEGORY CHANGE: Category changes will cost R20 after information has been captured.

ROUTE

40 - 49 (veteran)

ENTRY PROCEDURE: ENTER For easy entry, enter ONLINE at www.ecr.co.za or go to a selected Totalsports store in KZN, with your completed entry form, pay the entry fee, and collect your reference number (see the back of entry form for Totalsports store lists).

Gender: M/F

*Age Group - 20km walkers, please complete the following for certificate purposes: 17 & under (junior)

DISTANCE:

Please note: Early Entry Perks

Entries Open: 6 April 2011 Entries Close: First 20 000 entries received or 6 May 2011 Entry Fee: The Discovery East Coast Radio Big Walk is an official KZN Athletics sanctioned event. All walkers who are NOT in possession of a valid Athletics permanent licence must purchase a temporary licence in order to participate. The entry fee has been subsidised to accommodate this licence. Please note: • All walkers (irrespective of temporary or permanent licence) will be required to pay upon entry, the “Total Entry Fee” as indicated in the table below. • Permanent licensed walkers will be refunded the applicable temporary licence fee at Registration, ONLY If: • A valid license number has been provided on the entry form, and • Proof of this licence number is provided at Registration upon collection of walk packs. Total Entry Fee Timed/Non-Timed Entry Fee Distance Minimum Age to enter Athletics Temp Licence Fee Including Temp Athetics Licence Fee R50

For Office Use Only.

Signature of Parent/Guardian (if under 18yrs):

To be eligible for the main prize and any other prizes you are required to wear your 2011 Discovery East Coast Radio Big Walk t-shirt, and be present at the draw on event day. Walkers must wear their official event race number on their chests and the temporary or permanent Athletics licence number on the back. No one is allowed to walk using another person’s race number. There will be no refund in the event of an entrant not participating. All events are subject to the rules of IAAF, ASA and KZNA. All foreign athletes must comply by IAAF rule 4.2 and 142. No personal seconding is allowed.

RELEASE AND WAIVER I am in good health, physically fit and have sufficiently trained to participate in this event. I agree to comply with the rules, conditions of entry and regulations for this event which includes the payment of entry fee. I hereby discharge the organizers of the Discovery East Coast Radio Big Walk, all sponsors, volunteer groups, medical personnel, and all local authorities, from any loss or damage, however caused, arising from my participation in the event, including pre-race and post race activities. This waiver applies to my executors, heirs, administrators, assigns and myself. I grant permission to the organizers and sponsors, in section 51 of the Electronic Communications Transactions Act 25 of 2002, to use my name, race information and any photographs, video tape, broadcast and/or telecast footage in which I may appear, for whatever use, at no charge. Persons signing this entry form as guardian of a minor hereby consent to minor being bound by the foregoing and further indemnify the organizers and the aforementioned parties to the extent, if any, to which such minor is not capable of waiving his/her rights as stipulated above. The Organisers reserves the right to cancel the Discovery East Coast Radio Big Walk at any stage, even after it has commenced, should they, in their sole discretion, decide that it is not in the interest of the walkers or the Discovery East Coast Radio Big Walk itself to hold the Discovery East Coast Radio Big Walk on account of extremely adverse weather conditions, civil commotion; political unrest; riots; blockades; threats of violence or intimidation; circumstances where the safety of the walkers in question or any other good cause. In the event of the Discovery East Coast Radio Big Walk being cancelled, pursuant of the aforegoing, participants will not be refunded their entry fees.


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