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Gender MaleFemale ID or Passport Nationality Date of Birth Kit Size XSSMLXLXXL Contact Number Accommodation is shared Emergency Contact Person (Name & Contact Number) Medical Aid Medical Aid Number Medical Aid Main Member Current Chronic Medication Specify Any Medical Conditions/ Disabilities/ Allergies/ Dietary Needs Terms and Conditions By virtue of your entrance to the 1965Ride, you accept the terms and conditions of the indemnity below Waiver & Indemnity Participants hereby acknowledge that they take part in The Ride and all functions and events related thereto entirely at their own risk and agree that they and their dependants waive and shall not, nor shall they institute any claims whatsoever against, and do hereby indemnify and hold harmless from all liability, Education Endowment Fund, its associate organisations and/ or the organisers of The 1965Ride. Participants also hereby commit to raising a minimum of R30 000. The first R10 000 falls due before the start of the 1965Ride and the balance is due by 31 May of that year. I hereby accept the Waiver and Indemnity I hereby accept the Waiver and Indemnity Minimum Sponsorship Target: R30000 per person Banking Details: Account Name: Education Endowment Fund npc Bank: Nedbank Branch Code: 168405 Account number: 1137352671 Account Type: Cheque SWIFT Code: NEDSZAJJ Reference: Cyclists’ Name
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