Entry Form

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Select One *

Choose One *

Need 1 x Fluid Kayak - R500 Need 2 x Fluid Kayak - R1000 Have own boat

Team Name *

Team Captain *

First

Last

Phone Number *

Team Member 1 - ID Number *

Team Member 1 - Medical Aid Name and Number *

Team Member 2 Name and Surname *

First

Last

Team Member 2 - ID Number *

Email *

Team Member 2 - Medical Aid Name and Number *

Team Member 3 Name and Surname *

First

Last

Team Member 3 - ID Number *

Team Member 3 - Medical Aid Name and Number *

Team Member 4 Name and Surname *

First

Last

Team Member 4 - ID Number *

Team Member 4 - Medical Aid Name and Number *

How many people will be camping? *

Banking Details:
FNB
Franco Olivier
62395586913
Branch Code: 250655
Account type: Cheque Account

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