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Bike 4 Kids Registration Form

Saturday 2nd December 2017

PERSONAL DETAILS :

Frist Name*

Last Name*

Date of Birth*


Age Years

Gender

Nationality

Email Address

Phone Number*

Address*

Emergency Contact *

Phone

T-shirt Size

Race Distance

EVENT INFORMATION :

  1. Saturday 2nd December
  2. Starts from 6am at Elephant Terrace
  3. Distances available:
    • 17KM
    • 37KM
    • 100KM
  4. Costs do not change depending on the distance, (this year all staff will get a new T Shirt):
    • Cambodian Adult - $30
    • Cambodian Under 16yo - $15
    • International Adult - $90
    • International Under 16yo - $30
  5. Registration deadline = Monday 16th October