Fitness Challenge Complete the Form Below Fitness Challenge Who is entering? Select Option Below Group of 4 (minimum 2 women) - R400 per group Single male - R100 pp Single female - R100 pp Children (8-18 years) - R100 pp Select Your Entry Date Below * Select Date 29/30 May 2020 21/22 Aug 2020 27/28 Nov 2020 Group of 4 Group Name * Maximum 4 Members (2 x Members must be Female) Main Member Email Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Members Details Member Name Member Surname Member Date of Birth Member Cell Number Add Another Member Remove Member Your Details Name * Surname * Date of Birth * Cell Number * Email Accept Terms and Conditions as below * YES NO All entries must be present on the day of prize giving. I declare that: 1. My accepted entry into the Event will not be transferred to another entrant. 2. In the event of any ‘act of God’ conditions causing a cancellation of the event, I agree that my total entry fee is not transferable or refundable. 3. I am in an appropriate physical condition to participate in the event, given the known parameters of the Event (such as the length, time, physical demands and environmental context). 4. I have taken medical advice on any pre-existing medical conditions, and confirm that it is medically safe for me to participate in the Event. 5. I acknowledge that there are risks involved in the Event. I fully realize the dangers of participating in the Event and fully assume the risks associated with my participation and my wellbeing and safety during and after the event. I understand and acknowledge that the Event organizers (including all officials and event volunteers) provide no warranties, regarding my wellbeing and safety. 6. I understand and agree that situations may arise during the Event, which may be beyond the immediate control of the event organizers (including all officials and event volunteers). 7. I will participate in the Event, in a manner that does not endanger either me or others. 8. I agree that to the extent permissible by law, the Event organizers (including all officials and event volunteers), the sponsors and other parties associated with the Event, have no liability to me whatsoever for any direct or indirect loss, (including, but not limited to injury or death) sustained by me during or in any way related to my participation in the Event. 9. I authorize the use of my name, voice, picture and information on this entry form in any broadcast, telecast, promotion, advertising, and in any other way, without payment to me or any other form of compensation. 10. I agree to comply with the rules, and regulations pertaining to the Event. 11. I agree to follow all reasonable safety instructions provided to me by the Event organizers, (including all officials and event volunteers) before, during and after the event. 12. I consent to receive medical treatment in the event of illness or injuries suffered during or immediately after the Event. reCAPTCHA Submit
