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Entry form Le Fruit Triathlon - Viet Adventure


									                                                                                       RACE DETAILS

                             Saturday 29th of May 2010                                                   Suoi Nuoc Beach, Mui Ne, Binh Thuan province, Vietnam

CATEGORY                                                               Age                                 Race details                                   DEPARTURE TIME
                                                                                               750m open water swim
Stamina (long)                                      Over 16 years old                          40km mountain bike                                                 2.20pm
                                                                                               10 km off road run
                                                                                               300m open water swim
Spint (short)                                       Any age                                    20km mountain bike                                                 2.40pm
                                                                                               5 km off road run
                                                                                               100m open water swim
Gecko                                               6 to 12 years old                          3km mountain bike                                                  5.30pm
                                                                                               1000m off road run

                                            Gear List                                                                           Registration Deadline
1 mountain bike per person                          2 liters of water minimum/person           Wednesday 19th of May 2010
1 helmet per person (compulsory)                    Suncream
1 small backpack
1 inner tube + 1 pomp + tools to fix bike

                                                    We work on every aspect of the events to identify where waste and carbon impact can be minimized. Beach
An event without a trace                            Cleaning Initiative to provide clean and safe beaches for the bare feet of the triathletes, and also for the bare
                                                    feet of the next generation.

Our intent is to help children in need from the fishermen village next to Mui Ne to thrive in food-secure environment and to finance their education

                                                                           RACE REGISTRATION FORM


                                                     Do you also race for a company?
                                                                Yes or no
                                                    If yes, please provide the name of
                                                               your company:
                                                    Full name



                                                    Passport Number

                                                    Year of Birth


                                                    Country of residence
                                                    Phone number


                                                    Medical conditions

                                                    Known allergies

                                                    Emergency contact person
                                                    Full Name

                                                    Emergency contact person
                                                    Phone number

                                                                         COMPETITOR'S DECLARATION
The said form is complete with a view to the fact that I am aware of the danger inherent in this type of races.
I hereby declare and certify that:
a) I am physically fit and have sufficiently trained to take part in the Event
b) I have no medical conditions that I am aware of that would place myself or others at risk or harm as a result of my participation in the Event.
My doctor guarantees that I can participate to such Event.
c) I am aware that swimming, cycling and running are potentially hazardous activities in an uncontrolled open course environment and carry with them to potential for serious injury.
d) I hereby agree to assume all risks associated with my participation in the Event.
e) I realise that liability may arise from negligence or carelessness on the part of ourselves, my fellow participants or any of all the persons, corporations, and bodies involved in the

Further, having carefully read the above waiver and all risks being known and appreciated by me and in consideration of my participation in the Event, I hereby take responsibility for
myself and anyone entitled to act on my behalf and hereby declare that I:
a) Waive, release and discharge from any and all liability for my death, disability, personal injury, property theft and actions of any kind however caused which my hereafter accrue to
me, all persons, corporations, and bodies invloved in the Event and the service agents, representatives and officers or any of them.
b) Indemnify and hold harmless all persons, corporations and bodies involved in the Event and the service agents, representatives and officers or any of them from any of all liabilities
or claims made as a result of participation in the race, whether caused by negligence or otherwise.
c) Authorize the organizers to use any picture or video of me taken during the race for interal or media purposes.

                                                                                                                       ____________________________ (signature)
                                            Date:                                                                        Consents to the Viet Adventure Disclaimer

                                  Please return the completed application to Viet Adventure by Fax + 84 8 35 12 04 91 or Email:
                                                                            SERVICES BOOKING
Please select the services required
LIST OF SERVICES                                               Unit price                                    Quantity                                  Total in VND
Stamina Competitor's Package
Race registration + Insurance + Race T-shirt                 900,000 VND                                                                                   0 VND
Sprint Competitor's Package
Race registration + Insurance + Race T-shirt                 750,000 VND                                                                                   0 VND
Competitor's Package - Gecko
children under 12 years old                                  400,000 VND                                                                                   0 VND
Race registration + Insurance + Race T-shirt

** If Parents (both dad & mom) participate in the Competitor's Package --> Free for 1 Children in the Gecko's package

Non Competitor's Package
                                                             250,000 VND                                                                                   0 VND


Mountain bike rental
1 day, TREK or GIANT bike                                    400,000 VND
                                                                                                                                                           0 VND
Transport not included
Indicate frame height required                 20 bikes available (1st come, 1st served)
                                                          Height in meters:
Shuttle bus (2ways) - FRIDAY
                                                             300,000 VND                                                                                   0 VND
HCMC - Phan Thiet - HCMC
Shuttle bus (2ways) - SATURDAY
                                                             300,000 VND                                                                                   0 VND
HCMC - Phan Thiet - HCMC

Personal bike transportation                                 200,000 VND                                                                                   0 VND

                                                                                                                               TOTAL                                         0 VND

                                                                              PAYMENT DETAILS
By bank transfer                                                                           By cash
Account holder: CTY TNHH MAO HIEM VIET ( VIET ADVENTURE)                                   Payment to Viet Adventure Ltd
Bank: NGAN HANG XUAT NHAP KHAU VIET NAM - EIB SO GIAO DICH 1                               Address: 150 - D2 Street - Binh Thanh District - Ward 25 - Hochiminh City - Vietnam
VND account No: 200014851121835                                                            Tel: + 84 12 83 64 89 37
USD account No: 200014851121849
Swift code: EBVIVNVX1CB
                                                                             BOOKING CONTACT
Contact Full Name                                                                          Tel
Email                                                                                      Address
Company name                                                                               VAT number
                                                              NON - COMPETITORS REGISTRATION FORM
                                                             Full Name                                Passport Number


Remember that we can help you plan your Team Building program, travel and sport escape in Vietnam.
Feel free to contact us at
For foreign visitors, note that you need VISA to enter Vietnam. Please contact your local Vietnam Embassy.

                                 Please return the completed application to Viet Adventure by Fax + 84 8 35 12 04 91 or Email:

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