Your Name & Surname (required)
Your Email (required)
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.
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
