Pokeno Wheels & Heels Cycle Challenge

Individual Event Online Registration

All registered participants gain entry to draw for prizes.
Pre Event Entries close Wednesday 7th March 2012.
Please complete one entry for each individual in the “Wheels &Heels” Event.
After completing this entry form an invoice will be auto-generated on your browser. Do not refresh your browser.
Print the invoice and forward it to ExcellentEvents NZ Ltd with your payment.

Details for the Individual entry: Fields with an * must be completed
Participant Details:
First Name:*
Last Name:*
 
Male Female
Are you under 18 years Yes
Team / School
Postal Address Information:
Street / Box Number:*
Suburb / Town:*
City / District:
Phone:
email:*
Cycle Challenge Entry and Fees:
I wish to enter the following event: * 70 Km Pro Bike Challenge - $40.00
32 Km Recreational Bike Challenge- $40.00
Previous participation:
  I have taken part in this event in previous years    I am new to this event
Preferred Payment option :
Cheque           Direct Credit           Credit Card
CONDITIONS OF ENTRY
*I have read and understand the conditions of entry
Yes No

* To accept the Conditions of Entry, type your name here (A Guardian/Caregivers name is required for participants under 18 years of age at time of registration)
Guardian/Caregiver
 

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