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					          TRIPLE CHALLENGE ENTRY FORM - 2013
Surname                                                                        First name:

ID no:                                                                         Gender:              M      F

Club:                                                                          2013 License no:

Email address:                                                                 Contact no:

Did you complete the Triple Challenge 2012 ?                            Y       N



 All competitors: I declare that I agree to abide by the rules of the event. I will participate in the races at my
own risk and hereby indemnify the national and provincial bodies, sponsors and organizers of the race against any
            action or claim of whatsoever nature, which may result out of my participation in the event.




                    Signature / or parents                                                   Date

T-shirt size:

Small                      Medium                         Large                      X-Large                     XX-Large


           !!!!!!!!!!!!!!! Entry fee R 290 - Temporary licences NOT included !!!!!!!!!!!!!!!!!!!!

                                                          Admin use only !!!

Entry done at:                                                                  Entry fee recieved:

  Entry date:                                                                    Cash received by:

 Race number:
  Spar Lantern                               Clover Irene Spring                                    Liquifruit

  Finish time:
  Spar Lantern                               Clover Irene Spring                                    Liquifruit

            Note: Grey areas = to be completed by IRRC member




                TRIPLE CHALLENGE RECEIPT - 2013

Surname:                                                                       First name:


Irene signature:                                                               Entered at:


Date:                                                                          Amount paid:

				
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