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WINKLE SKI CLUB
KWAZULU-NATAL FISHING SKI INTERCLUB
ENTRY FORM
17-18 April 2010
Team name : _____________________________________
Club representative : _____________________________________
Contact number : _____________________________________
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Captain : ___________________________
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Tel : _____________________________
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e-Mail : ____________________________
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T-shirt size : _______________________
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Member 1 : _________________________
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Tel : _____________________________
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e-Mail : ____________________________
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T-shirt size : _______________________
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Member 2 : _________________________
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Tel : _____________________________
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e-Mail : ____________________________
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T-shirt size : _______________________
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Member 3 : _________________________
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Tel : _____________________________
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e-Mail : ____________________________
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T-shirt size : _______________________
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Pre-entry fee is R150 per paddler, R600 per team up to end of March. There after, entry fee is R200 per paddler, R800 per team. If you do not have a complete team, Vernon Malyon (084 316 7639) will assist you to complete your team with members at the pre briefing on the 23rd of April 18H30 at the Winklespruit Lifesaving club. Please ensure that the indemnity form is signed and faxed with the proof of payment. Please use your captain’s surname as reference.
Banking Details: Winklespruit Fishing Ski Club
FNB Amanzimtoti
Branch code: 220127
Account No: 62156898755
Fax proof of payment, entry form and indemnity to: 0866256764.
Indemnity
We, the undersigned,
1) ________________________________
2) ________________________________
3) ________________________________
4) ________________________________
waive, release, indemnify and forever discharge Winklespruit Lifesaving Club, its officers, agents, employees and representatives against any claim which may result from my participation in the aforementioned fishing-ski competition.
Signatures :
1) _______________________ 2) __________________________
3) _______________________ 4) __________________________
Date : _______________________ Place : ________________________________
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