Entry Form ALL PRE-ENTRIES TO RECEIVE 3 LUCKY DRAW TICKETS CUT OFF DAY IS 20/01/17 Please complete separate entry forms for rider and pillion Click here for the downloadable PDF version Please complete allName *Surname *ID Number *Postal Address *Tel Number OptionalCellphone Number *Email Address *Club Name *Rider or Pillion R200 *RiderPillionPre order T-Shirt (R120) *XXLXLLMSNo ThanksPre order a Cap? (R80) *Yes PleaseNo ThanksINDEMNITY: *By ticking the box below, I hereby agree that I am attending the Steppies Rally entirely at my own risk and indemnify the organizers of any damages sustained by my person or my belongings which may result from my participation in the event. I confirm that I am 18 years or older and agree to abide by the rules and instructions of the organizers and their agents. I have read and understood the above and all the instructionsI agree VerificationPlease enter any two digits *Example: 12This box is for spam protection - please leave it blank: All payments to be done via EFT and or ATM deposits. Teller deposits cost R50 more. Please use your FULL name and SURNAME as reference when making payment. Fax or Email Proof of payment to: 086 594 8737 / stepchildrenmcc@gmail.com PAYMENTS AT THE RALLY WILL BE CASH ONLY THIS RALLY IS FOR ADULTS ONLY OVER 18’s ONLY PLEASE
