| Application
Form
HIMALAYAN
MOUNTAIN BIKE - ACTION ASIA RACE SERIES 2001
PLEASE PRINT FORM AND COMPLETE
IN CAPITAL LETTERS.
Category (age as at
10th December 2001) :
Open
Master's (over 40 yrs)
Women
Juniors (under 18 yrs)
School Teams
Personal Information
:
We have read and agree
to the Terms & Conditions set out here on the previous webpage.
Please
tick the box if you would like to offer a volunteer to help with any
of the races.
Volunteers will recieve
a T-shirt / cap and meal on race day.
Individual
Entry
Name: _________________________
Nationality: ______________________
Entry me in:
The Series:
or Race 1 / 2 / 3
Sex :
M F
Date of Birth (d/m/y) :
___/ ___/ 200___
Phone: (w)____________(h)____________
(mobile)______________
Fax : __________________
Email : ______________________________________
Address: ____________________________________
____________________________________________
____________________________________________
T-shirt size : (s/ m/ l/
xl)____
Past Medical History/Known
Allergies:
____________________________________________
____________________________________________
Signature: __________________________________
Date_____________
In case of emergency during
the event, please contact:
Mr./Mrs.________________________
Tel: Area Code: _________________________
School's
(Please
note that each school team must consist of three members)
School Team Name:
_____________________________
Team Captain*: _____________________________
Sex :
M F
Date of Birth (d/m/y) :
____/ ____/ 200____
Phone: (h)_______________
(school)_______________
School Extra Curricular
Activities teacher:
Name:__________________________
Fax:____________________
Email : ______________________________________
Address:_____________________________________
____________________________________________
____________________________________________
T-shirt size : (s/ m/ l/
xl) ____
Past Medical History/Known
Allergies:
____________________________________________
____________________________________________
Signature: __________________________________
Date: _____________
In case of emergency during
the event, please contact:
Mr./Mrs.________________________
Tel: .________________________
Please note that School
teams must have all 3 members who are currently attending their School.
Team Member # 2 :
_________________________
Sex :
M F
Date of Birth (d/m/y) :
___/ ___/ 200___
Phone: (w)_________(h)____________
Fax : __________________
Email : ______________________________________
Address: ____________________________________
____________________________________________
____________________________________________
T-shirt size : (s/ m/ l/
xl)____
Past Medical History/Known
Allergies:
____________________________________________
____________________________________________
Signature: __________________________________
Date_____________
In case of emergency during
the event, please contact:
Mr./Mrs.________________________
Tel: .________________________
Team Member # 3 :
__________________________
Sex :
M F
Date of Birth (d/m/y): ___/
___/ 200____
Phone: (w)___________(h)___________
Fax : __________________
Email : ___________________________________
Address : ___________________________________
____________________________________________
____________________________________________
T-shirt size : (s/ m/ l/
xl) ____
Past Medical History/Known
Allergies:
____________________________________________
____________________________________________
Signature: __________________________________
Date: _____________
In case of emergency during
the event, please contact:
Mr./Mrs.________________________
Tel: .________________________
Teams must notify the organizer
of any change of team member by fax or e-mail no less than 7 days
prior to race day.
Please
tick the box if you would like to offer a volunteer to help with any
of the races.
*All correspondence
will be mailed to the team captain
Payment enclosed:
TOTAL AMOUNT ENCLOSED (please
specify currency) ________________
Cheque Number: ______________________
Credit card &
bank transfers
can be made.
For
Race schedule updates or more information please email: hmb@bikeasia.info
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