KIWL 500 2022 Application

How did you hear about the KIWL 500 cycle ride?Tick one

I am a KIWL 500 Veteran

Social Media

KIWL website

Through a colleague/friend/acquaintance

Other

Name* This field is required.

First Name

Last Name

Date of Birth* This field is required.

Date/Month/Year

Contact Details* This field is required.Emergency contact details will only be used in the event of an accident during the event.

Email address for correspondence

Employer or Business Name

Cellphone Number

Emergency Contact Number

Emergency Contact Person

How would you describe your cycling ability?KIWL 500 is not suitable for absolute beginners. Cyclists must have experience and time to sufficiently train.

New to Cycling (less than 1 year)

Occasional leisure cyclist

Regular weekend/weekday cyclist

Competing/Advanced cyclist

If my application is approved...* This field is required.Please read, understand, and tick all

I shall abide by Japanese traffic laws, use a roadworthy racing bike (with lights & bell), and wear a helmet

I will provide evidence of bicycle insurance before the event.

I may be asked to withdraw if I am not sufficiently trained one month before the event (able to ride 100km+ per day for 4 consecutive days)

I will submit to a PCR test and/or show proof of vaccination if requested

I understand the KIWL 500 is mainly a fundraising event. My commitment is to raise at least Y50,000 in donations before the event. If I do not, I shall be asked to donate Y50,000 myself before the event to keep my place.

How Shall I Raise Funds?* This field is required.My fundraising contribution will be....

a personal donation of Y50,000 or more.

Y50,000 or more in donations from friends, colleagues & family

sourcing a corporate sponsor for the KIWL 500 2022 jersey

hosting an event to raise at least Y50,000 (e.g social event, sports event)

my company providing gifts in-kind of at least Y50,000 in support of the event

A combination of one or more the above

Other

Corporate SponsorsIf you can introduce corporate sponsors, the participation fee is discounted to Y100,000 although you can still seek personal donations if you wish. Are you able to introduce a sponsoring company to KIWL?

Yes

Maybe

Acknowledgements* This field is required.Please read and tick ALL boxes

I understand KIWL, its members, event participants, sponsors and charity partners are not responsible or liable for my personal injury, illness, or death as a result of my participation. I will participate entirely at my own risk and accept the health risks of doing so. 私は、KIWL、所属メンバー、イベント参加者、スポンサー及び慈善団体が、私の参加により生じた個人的な負傷や病気または死亡について一切の責任を負わないことを十分に理解します。私は、完全に自らの責任で参加し、これに伴う健康上のリスクを受諾します。

I understand KIWL, its members, event participants, sponsors and charity partners are not responsible or liable for any claims arising from accidents to which I am a party during the ride dates. 私は、KIWL、所属メンバー、イベント参加者、スポンサー及び慈善団体が、走行中に私が当事者となった事故に起因するいかなる請求についても、一切の責任を負わないことを理解します。

I understand if some or all of the event is cancelled due to extenuating circumstances (e.g. inclement weather, natural disaster, pandemic), I will not be refunded pre-paid costs, including but not limited to KIWL kit, accommodation, and donations. 私は、やむを得ない事情（例えば、悪天候や自然災害）によりイベントの一部または全行程が中止された場合、KIWL専用キット、宿泊費、寄付金等を含む（但し、これに限定されない）支払い済みの費用が返還されないことを理解します。

I understand KIWL 500 2022 organizors and all related parties shall not have any liability to participants or support crew. 私は、KIWL500 2022の主催者及びすべての関係者が、参加者やサポート・クルーに対しいかなる責任も負わないことを理解します。

I accept and understand the event participation fee is Y150,000 if I do not conduct any fundraising 私は、募金活動を行わなかった場合のイベント参加費が15万円であることに同意します.

I have sufficient English language ability to understand instructions and requirements. 私は、指示や要求を理解するに足る十分な英語力を備えています

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Date* This field is required.Today's Date

Date/Month/Year

KIWL 500 2022 Application

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