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01C0 DAPEP:L17 JANUARY 2010
2 RA E AT I
SHIRT
D D M M Y Y SIZE XS S M L XL XXL
ALE
M FEMALE ATE OF BIRTH
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LAST NAME FIRST NAME AGE IN RACE YEAR
POSTAL ADDRESS SUBURB
CITY COUNTRY POSTAL CODE
CONTACT NO E-MAIL ADDRESS
PROFESSIONAL? Y N FIRST IRONMAN? Y N COUNTRY REPRESENTING
IDENTITY NUMBER (SOUTH AFRICA) OCCUPATION
MEDICAL AID PROVIDER MEDICAL AID NUMBER
EMERGENCY CONTACT PERSON TEL:
MEDICAL: do you wish the medical staff of the SPEC-SAVERS IRONMAN 70.3 SOUTH AFRICA TRIATHLON to be aware of any specific
medical problem? Have you required medical treatment during or after an endurance event? If yes, specify the medical treatment.
N Y IF YES PLEASE SPECIFY WITH ATTACHMENTS TO THIS DOCUMENT.
ENTRY FEES SPEC-SAVERS IRONMAN 70.3 SOUTH AFRICA 2010:
• Normal entry until 8 November 2009 African International
Please tick Appropriate Please tick Appropriate
• Late entry from 9 November - 27 November 2009
NORMAL LATE ENTRY NORMAL LATE ENTRY
1. NORMAL ENTRY FEE (individual only) R 1150 R 1500 € 130 € 170
2. * EXTRA GUEST CEREMONY AWARDS TICKET R 250 R 250 € 25 € 25
3. TRAINING TRI-TOP (unisex) XS S M L XL R 600 N/A € 65 N/A
4. TRAINING TRI-SHORTS (unisex) XS S M L XL R 580 N/A € 60 N/A
5. SPEC-SAVERS IRONMAN 70.3 SOUTH AFRICA 2010 DVD R 200 R 200 € 30 € 30
6. SPEC-SAVERS IRONMAN 70.3 SOUTH AFRICA 2009 DVD R 200 R 200 € 30 € 30
7. BEADED CHARITY M-DOT R 50 R 50 € 10 € 10
8. INSURANCE FOR WITHDRAWALS R 200 N/A € 25 N/A
(* Note: Awards Ceremony ticket is included in entry fee) TOTAL: R €
PAYMENT
VISA MASTERCARD
CARD TYPE CARD NUMBER EXPIRING DATE CVV (LAST 3 DIGITS ON BACK OF CARD)
BANK TRANSFERS SOUTH AFRICA
IRONMAN 70.3 SOUTH AFRICA • FIRST NATIONAL BANK, NEWTON PARK • ACB CODE: 261050 • ACCOUNT NUMBER: 621 463 663 82
• PLEASE INCLUDE PROOF OF PAYMENT WITH YOUR APPLICATION FORM • Fax +27 41 581 4553
DECLARATION: In consideration of the acceptance of my entry, I agree to observe the regulations set out in the official basic information booklet, and the race regulations of the national triathlon federation as well as the regulations of the management and organizers as
stated in the official programme. The organizer reserves the right to: change or modify the basic information booklet from time to time, and I agree to acquaint myself with such chances; change the format or course of the race as a result of prevailing conditions; cancel
the race because of force majeure. Any fee paid will not be refunded in case of a cancellation of race. Further claims cannot be asserted. Furthermore I agree to sign the waiver, release and indemnity form during the registration process, wherever it may be held, and
I confirm that I have had sight of and agree to the terms thereof. I acknowledge that the waiver, release and indemnity form is available at all times on the competition’s website. The application form together with the documents referred to therein constitutes the sole
recording of the agreement between the athlete and the Ironman 70.3 South Africa in respect of the matters referred to therein and no agreement varying or altering the contents of the agreement shall be of any force of effect unless recorded in writing and agreed to by
all the Parties to this agreement.
PLACE, DATE FIRSTNAME & LASTNAME IN CAPITAL LETTERS SIGNATURE
APPLICATIONS WITHOUT PAYMENT CONFIRMATION CANNOT BE PROCESSED!
PHYSICAL: 161 Main Road, Walmer, Port Elizabeth, 6070 • POSTAL: PO Box 40330, Walmer, Port Elizabeth, South Africa, 6065
Telephone : +27 (0) 41 581 7990 • Fax : +27 (0) 41 581 4553 • e-mail : office@ironman703.co.za • web: www.ironman703.co.za • Race Office tel: +27 (83) 900 IRON
Individuals
WORLD CHAMPIONSHIP QUALIFICATION CONDITION OF WITHDRAWAL:
The Spec-Savers IRONMAN 70.3 South Africa 2010 Triathlon offers 1. Sudden severe illness* – such as heart problems, sugar
50 Clearwater qualification slots for the 2010 IRONMAN World diabetes, hypertension, mental illness requiring hospitalization,
Championships 70.3. The respective qualification is only valid for the as long as the athlete is been diagnosed for the first time.
IRONMAN World Championship 70.3. The final allocation of slots will 2. Injury* – as a result of training or accident that will stop the
be calculated according to the number of starters in each category. athletes from training for longer than 4 weeks.
Athletes who wish to qualify for the World Championships have to 3. Death or severe injury of family dependant* – if a family
be present at the Clearwater slot distribution on Sunday, 17 January dependant is killed or severely injured requiring the athlete’s
2010. Professionals are not able to compete in the rankings of their presence/attention. Family dependants are deemed to be
age-group and therefore are not able to compete to get an Age Group the insured person’s spouse (or life partner living in the
World Championship qualification slot. same household), children (stepchildren, sons and daughter-
in-law, grandchildren), parents (step-parents, parents-in-law,
grandparents) and siblings.
Category age group slots 4. Pregnancy – if the pregnancy was not discovered until after
PRO Male x 4 the insured person has signed up for the Ironman 70.3. If
PRO Female x 2 the pregnancy was discovered prior to signing up for the
Age Groups A–K 44 Ironman 70.3, the nominal sum will only be refunded if severe
Total 50 complications arise in the pregnancy.
5. Substantial property damage – to the insured persons property
US $ 25 000 PRIZE MONEY at his/her place of residence as a results of nature (earthquake
The first 10 finishers, both male and female in the professional class will receive etc) or criminal offence committed by a third party, making the
prize money as long as they complete the race in within +10% of the finishing time insured person presence necessary.
of the second place finisher. Professionals do not qualify for prizes for the placing in
their age group. The prize money will be paid to the athletes as soon as the official *Conditions require a doctor’s letter.
doping test results have been received and cleared by the race director.
IMPORTANT:
The total prize money of U$ 25 000 will be distributed evenly between • Yes, the reason for withdrawal is one of the reasons listed
male and female professionals. above. I therefore fill in the withdrawal form and attach all
relevant documentation. (Doctors letters, insurance policies
Age Group Awards: or letters from police)
Special Spec-Savers Ironman 70.3 South African Trophies will be
awarded to the first three athletes in each age group category for both • No, the reason for withdrawal is none of the above.
male and female athletes: Therefore the cancellation policy of Ironman 70.3 South
Africa applies here as described above.
• 18-24 • 25-29 • 30-34 • 35-39 • 40-44 • 45-49
• 50-54 • 55-59 • 60-64 • 65-69 • 70-74 • 75-79 • 80+
Athletes MUST be present at the Awards Banquet on the 18 January
2010 to collect their Trophy
Teams
RULES AND REGULATIONS:
ATHLETE INFO GUIdE • ALL athletes MUST be above 16yrs of age
Please regularly check for changes and ensure you download your info • Any athlete may be substituted in the team up until closing of registra-
guide prior to race week
tion on Saturday, 17 January at 3pm
WITHDRAWAL • All rules applying to the individual athletes as mentioned in the
If an athlete does not select this insurance then the following conditions athlete info guide or on website apply to the teams. Please refer to
will apply: website for these rules
• ALL 3 athletes HAVE to sign the TEAM indemnity form at/or
1) Until 25 Sept 2009 – 25% cancellation fee prior to Registration. Race packs WILL NOT be given out
2) From 26 Sept - 8 Nov 2009 – 50% cancellation fee unless the indemnity is completed with all 3 signatures.
3) From 9 Nov 2009 – 100% cancellation fee
• Team medals and certificates will be specifically for teams only – this
An entry MAY NOT be carried over to the next year, given to another will not be the official Ironman 70.3 medals and certificates
person or used for another event. Payment for additional tickets for the • No slots will be available for teams to Ironman 70.3 World
Awards Banquets will be fully refunded until the 8 November 2009, as Champs in Clearwater
from the 9 November 2009 a 100% cancellation fee will also apply here.
PRIZE MONEY
The first 3 teams to finish will recieve prize money.
WITHDRAWAL INSURANCE (optional) • First Place = R 5 000
Ironman 70.3 South Africa will be offering a withdrawal insurance that
• Second Place = R 3 000
will cover the athlete’s registration fees (subject to the conditions listed
below). The cost of this insurance will be R100.00 which can be selected • Third Place = R 2 000
on the entry form. This insurance will pay 100% of the registration fee
back to the athlete until 8 January 2010. South African law is applicable,
place of jurisdiction is Port Elizabeth.
