KIWL Lite 2024 Application

1

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

I am a KIWL Veteran

Social Media

KIWL website

A colleague/friend/acquaintance

Other

2

Name* This field is required.

First Name

Last Name

3

Date of Birth* This field is required.

Date/Month/Year

4

Contact Details* This field is required.

Email address for KIWL communications

Employer or Business Name (or N/A)

Cellphone Number

5

Your Nationality* This field is required.

6

Emergency Contact* This field is required.Name & Telephone Number

7

Describe your cycling ability?KIWL 500 is not suitable for absolute beginners. Cyclists should have road cycling experience and ensure time can be given to sufficiently train over the next 5 months.

New to Cycling (less than 1 year)

Occasional leisure cyclist

Regular weekend/weekday cyclist

Competing/Advanced cyclist

8

If my application is approved...* This field is required.Please acknowledge the following by ticking each box.

I shall abide by Japanese road traffic laws, and wear a helmet at all times.

I have third party liability party bicycle insurance valid throughout the dates of the event

I acknowledge the dangers of road cycling and take full responsibility for my own safety

9

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 Lite organizors and all related parties shall not have any liability to participants or support crew. 私は、KIWL Lite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 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

10

Please e-sign below* This field is required.

Powered by Jotform SignClear

11

Date* This field is required.Today's Date

Date/Month/Year