SUNDAY 15 JUNE 2014 All registrations online or on the official entry form (See reverse) CONTACT Glenys Taylor P O Box 797 Palmerston North email
[email protected] website for online registration www.bikemanawatu.co.nz
ENTRY FORM FIRST NAME:
PROGRAMME OUTLINE
LAST NAME:
8.00 am Registration Ashhurst School Hall
EMAIL:
8.30 am Event briefing (ALL participants must attend) 9.00 am Hill Climb Individual Time Trial 3km
DOB
11.00am Individual Time Trial 10km
AGE GROUP : Year 7/8 U 15 U 17U 19
2.00 pm Points race (number of laps depends on age group)
/
/
MALE / FEMALE
4.30pm Prize giving Ashhurst School Hall
SCHOOL:
AGE GROUPS
EMERGENCY CONTACT NAME:
Year 7/8, under 15, under 17, under 20 (boys and girls )
RELATIONSHIP :
Age as at 31 December 2014
PHONE:
ENTRY FEE
WHICH EVENTS ARE YOU TAKING PART IN?
$15 (Covers all 3 events)
Individual Hill Climb Individual Time trial Points Race
ENTRIES CLOSE
3km
( entry fee covers all 3 events)
10km $15 entry fee enclosed Direct credit to bank Date payment made / /
th
5pm on WEDNESDAY 11 JUNE NO LATE ENTRIES will be accepted SORRY, NO REFUNDS
RULES NZSCA rules apply to this event. For more information please see http://www.sportsground.co.nz/files/site/214/87/Pdf/1307082 25058NJCOCRIQ.pdf or contact Mike Simpson or Glenys Taylor (details below) In particular a maximum gearing of 7.93 m applies to under 19 and 6.61 m to all other grades. No carbon or composite wheels Only standard one piece drop handlebars are to be used. Helmets used in road events must comply with NZ traffic regulations and be Standards approved. School colours must be worn (or PE Top) NO SUPPORT VEHICLES ARE ALLOWED ON THE COURSE. Participants need to be present at prizegiving to receive prizes wearing full school cycle uniform.
CONDITIONS OF ENTRY In the consideration of the acceptance of this entry, I hereby agree to the exclusion of liability for Bike Manawatu Inc, Sport Manawatu, event organisers, officers of the club, sponsors, volunteers from all claims for injuries or damage however caused (whether fatal or otherwise) that I may suffer out of the participation in this event. I also release and forever discharge the above from all actions, suits, proceedings, claims, demands, losses , damages, penalties and fines however arising ( including negligence ). I also agree that I will comply with the rules of the school cycling Manawatu school champs 2014. I understand that I compete entirely at my own risk. I authorise the event organiser to use any photographs taken of me at the event for event promotional purposes. _________________________ Participant Name
__________________________ Parent/Guardian Name
_________________________ Participant Signature
__________________________ Parent/Guardian Signature
If entrant is under 18 years of age a parent/guardian signature is required
YEAR 7/8 TROPHY The van Wagtendonk Trophy will be awarded to the school with the most points for year 7/8 participants. Points are awarded to participants as well as to placegetters in each event.
PLEASE RETURN COMPLETED ENTRY FORM TO BIKE MANAWATU, P O BOX 797, PALMERSTON NORTH
PAYMENT METHODS Cheque payable to “Bike Manawatu” Direct credit to 01 0745 0284925 00 Please state “NAME” as description
FOR FURTHER INFORMATION Mike Simpson Glenys Taylor
06 3269 559 06 3289 862
027 505 8458 021 260 5536
[email protected] [email protected]
