Lifestyle Performance Cycling Club hosted by together with Central Gauteng Cycling
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: __________________________
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