2011 HANSA FISH ONLINE K3 LATE ENTRY FORM
Complete online, then print out and fax with the bank deposit slip to 048 881 9089.
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 :
emai	email	email

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 - Late R520 Junior - Late R375	Entry   Senior - Late R520 Junior - Late R375	Entry Senior - Late R520 Junior - Late R375
Extra meals None One set R145 Two sets R290	Extra meals None One set R145 Two sets R290	Extra meals None One set R145 Two sets R290
Credit Card fee	None K3 R105	Total :R
Have you done 10 Fishs? Yes No	Have you done 10 Fishs? Yes No	Have you done 10 oFishs? Yes No
Is this your first Fish?    Yes No	Is this your first Fish?    Yes No	Is this 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 .
___________________________ Signature of Paddler 1 ___________________________Signature of Parent/guardian if under 21 yrs old ___________________________ Signature of Paddler 2  ___________________________Signature of Parent/guardian if under 21 yrs old ___________________________ Signature of Paddler  3 ___________________________Signature of Parent/guardian if under 21 yrs old

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, 2 September 2011

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