Kirwans Heli-bike Registration Form First Name _______________ Last Name _________________________ Address _______________________________________________________ Phone ___________________ Mobile _______________________ Email _____________________________________ DOB: _____________________ How did you hear about the event?____________________________________ Social Enduro: The “social enduro” is a casual see who can get to the bottom the fastest. There will be no race numbers issued and there will be no official winner. As stated in the terms and condtions, the track will still be open to the public so you will still need to follow the mountain bikers code. However we will try our best to inform other users of the track so your run down can be as clear as possible. There is no extra cost Would you like to participate in the social enduro?___________________ Emergency Contact Details: Name ________________________ Phone __________________ Health Issues: ___________________________________________ Declaration:
By signing below you are confirming you have read and accept the terms and conditions:
Signed ____________________________ Date __________________ Parent/Guardian (if under 18) __________________________ Payment options: We prefer payment by online banking to Reefton I-site Visitor Centre 02-0880-0053599-000 (Use your last name as reference). If you choose to pay by Cheque make it out to Reefton I-site Visitor Centre. Terms and Conditions
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Full payment must be made before the entry is accepted
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The participation by riders in the Quartzopolis Classic is accepted on the understanding that: Riders acknowledge that they are aware of the dangers of mountain biking & compete in the event at their own risk; Riders must read and understand any written race instructions and follow all instructions, whether written or verbal. The organisers have done their best to make the event as safe as they can. Riders are responsible for ensuring that their bikes, helmets and other equipment are safe for use in the event; Any rider involved in an accident will not seek to make a claim against the organisers or assist anyone else in making a claim; If riders have any concerns with the race organisation, they must raise them with the organisers first. They must not raise them with any other person, recognising that they will only jeopardise the continuation of the event; The organiser's are excluded from any form of indirect loss or damage suffered by a rider or any other person associated with the rider; The Race uses public tracks and participants must follow the Mountain Bikers Code when encountering any other members of the public using tracks on the course.
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I give permission for my contact details to be passed to the events direct sponsors and partners, and: to be held by Reefton I-site in order to administer the race. I understand my details will be held securely and I am able to access them on request to the Reefton I-site
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If you have any medical concerns regarding your ability to participate in an activity (eg level of fitness, ability or skill) we recommend you seek appropriate medical advice.
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The organisers accept no responsibility or liability for any loss or damage to personal property.
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I agree and accept that the organised ride involves a degree of risk and that the race is considered an ‘advanced level’ mountain bike ride.
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I authorise my name, voice, picture or any information provided by me to be used without payment in any capacity relating to a further event run by the organisers.
For more information and to submit your entry EMAIL rvcinfo@xtra.co.nz or POST Quartzopolis Classic PO Box 100, Reefton 7830 New Zealand or visit www.quartzopolis.co.nz/events PH 03 732 8391 or 027 481 4222