2012 HANSA FISH ONLINE K3 ENTRY FORM

BOAT NUMBER Class: K3

Paddler One	Paddler Two	Paddler Three
CSA Registration Number :	CSA Registration Number :	CSA Registration Number :
Surname:	Surname:	Surname:
Initials:First Name:	Initials:First Name:	Initials:First Name:
ID Number:	ID Number:	ID Number:
Club: Date of birth :	Club: Date of birth :	Club: Date of birth :
Sex: Male Female	Sex: Male Female	Sex: Male Female
Category: Junior Senior Sub-Veteran Veteran Sub-Master Master Sub-Grand Master Grand Master	Category: Junior Senior Sub-Veteran Veteran Sub-Master Master Sub-Grand Master Grand Master	Category: Junior Senior Sub-Veteran Veteran Sub-Master Master Sub-Grand Master Grand Master
Postal Address:	Postal Address:	Postal Address:
Postal Code:	Postal Code:	Postal Code:
Telephone - work:	Telephone - work:	Telephone - work:
Telephone - home:	Telephone - home:	Telephone - home:
Telephone - fax :	Telephone - fax :	Telephone - fax :
Telephone - cell :	Telephone - cell :	Telephone - cell :
e-mail :	e-mail :	e-mail :

T-Shirt size: X-Small Small Medium Large X-Large XX-Large XXX-Large	T-Shirt size: X-Small Small Medium Large X-Large XX-Large XXX-Large	T-Shirt size: X-Small Small Medium Large X-Large XX-Large XXX-Large
Entry   Senior - Very Late R650 Junior - Very Late - R500	Entry   Senior- Very Late - R650 Junior - Very Late R500	Entry Senior - Very Late - R650 Junior - Very Late - R500
Extra meals None One set R150 Two sets R300	Extra meals None One set R150 Two sets R300	Extra meals None One set R150 Two sets R300
Credit Card fee	None K3 R120
Total R
Have you completed 10 or more Fishs? Yes No	Have you completed 10 or more Fishs? Yes No	Have you completed 10 or more Fishs? Yes No
Are you taking part in your first Fish?    Yes No	Are you taking part in your first Fish?    Yes No	Are you taking part in your first Fish?    Yes No
Special Class :    Parent and Child Siblings Mixed Triple Ladies triple Coelacanth batch Husband and Wife None

INDEMNITY: I/We, the undersigned, hereby declare that I/We am/are sufficiently competent to take part in the Hansa Fish, assume all risks of participation in the Fish Marathon, release and discharge the organisers and all their assistants as well as the sponsors from all claims arising for loss, damage, injury or death I/we may suffer arising from my/our participation in the race, and agree to abide by all the race and
CSA rules, which I/we have read and understood. I further certify that the information above is correct .

Click for digital signature Paddler 1 -  Signature of parent or guardian in the case of persons under 21 years old .
Click for digital signature Paddler 2 -  Signature of parent or guardian in the case of persons under 21 years old
Click for digital signature Paddler 3 -  Signature of parent or guardian in the case of persons under 21 years old
Paddlers  will be required to sign indemnity at registration

PLEASE NOTE:
By completing and submitting your race entry you acknowledge that you have read, understood and will abide by the race information and race rules.

Please make sure that you make your payment and submit a proof of payment at the same as faxing or emailing us your entry form. No entries will be processed.

BANKING DETAILS
The Fish Canoe Marathon
Standard Bank
Cradock branch
Branch code 050118
Account Number 082554501

All entries that have been received, confirmed as paid up and accepted will be posted here.

*ENTRY CLOSING DATE: Friday, 31 August 2012 at 17h00

All queries regarding entries can be directed to :
Pieter and Carien Kruger
Tel: (048) 881 1447
Fax: (048) 881 9089
Email: entriesATfishmarathon.org.za