hosted by
Lifestyle Performance Cycling Club
together with Central Gauteng Cycling
Saturday, 22 November 2014
Venue: Hector Norris Park
Registration: 07h00-08h30
Racing starts at 09h00
Name & Surname
Address
Age Category (please circle)
Elite Men
Ladies
Vet Men 35-49
Vet Men 50+
Junior Men
U16 boys
U14 boy/girl
Transition Category
Medical Aid
Med Aid No.
Cellphone No.
Email Address
Cycling Club
Licence No.
Emergency Contact Details:
Name:
Telephone no.
Categories & Events
Elite Men
1500m
Elimination
Keirin
Vet Men 35-49 and 50+
1500m
Elimination
Keirin
15 Lap points
Open Ladies
Junior and U16 Men
1500m
Elimination
Keirin
15 Lap points
Schools (U14)
Open Men
1500m
1500m
Sprint
Elimination
3km
Madison – 50
lap**
Keirin
500m Handicap
Transition Category
15 Lap Points
1500m
**U16 excluded from Madison. Madison will be raced, provided
minimum entry of 10 teams (alternative 30km Points)
Elimination
Entries close 19th November 2014
Keirin
15 Lap points
Entry fee: R160.00 per rider (Schools, Juniors & U16 – R100.00)
Held under the Rules of CSA and the U.C.I. Riders participate at their own risk.
2.
Registration at Hector Norris Park will take place on
Saturday, 22 November 2014, 07h00 – 08h30
Banking Details:
Lifestyle Performance Cycling Club, First National Bank, Bracken City Branch
Account No.620 147 651 61, Branch Code 252242, Reference: Track and Initial & Surname.
Please email entries forms together with proof of payment to: [email protected]
INDEMNITY
I, ________________________________________, hereby indemnify Central Gauteng Cycling, LPCC
and the organisers of the Joburg Grand Prix 2014 against any responsibility for any loss or
damage that may occur to me or my belongings due to me taking part in the Joburg Grand Prix
2014.
Signed: __________________________ on the ______________(date) ______________(place)
Print Name: _________________________
OR
I, ___________________________, being the legal parent / guardian of ________________________
Hereby grant my son/daughter permission to take part in the Joburg Grand Prix 2014. I also
hereby indemnify Central Gauteng Cycling, LPCC and the organisers of the Joburg Grand Prix
2014 against any responsibility for any loss or damage that may occur to my son/daughter or
their belongings due to him/her taking part in the Joburg Grand Prix 2014.
Signed: ___________________________on the ______________(date) ______________(place)
Print Name: __________________________