Jansenville

28 November 2026

Starts 16H00

ENTRY FORM

Personal Details

Name

First NameLast Name

ID Number:

Date of Birth:

DOB:

Email:

example@example.com

Phone Number (home):

Please enter a valid phone number.Format: (000) 000-0000.

Cell Number:

Please enter a valid phone number.Format: (000) 000-0000.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Medical Details

Medical Aid:

Medical Aid Number:

Emergency Contact Person:

Emergency Contact Number:

Allergies:

Who moticated you to enter?:

Club Name:

Race Nr (will be supplied):

Race Selection:

CSA day license R70.

If you are not a member of CSA or a cycling club affiliated to CSA, you will have to buy a one-day event day licence.

CSA Day License

CSA License Number:

Signature of Cyclist:

Signature of Parent/Guardian (if under 18):

PAYMENT DETAILS: FAX TO 0498360728

*Electronic or direct payment—
Reference: Name, surname and race distance
Angora MTB Classic, Standard Bank
Account nr: 035796952 Branch code 051001

*Or enter on day of event from 9h00 to 15h00

INDEMNITY:
Participant’s attention is drawn to the fact that, while the organizers have taken all reasonable steps to make the event as safe as possible, a MTB race will always carry inherent risks.

Cyclists are urged to exercise caution, especially those unfamiliar with the route. Please pay attention to signage and warnings. Cyclists take part at own risk and no claims against the organizers or their staff will be considered.

NO HELMET, NO RIDE!!!

Contact: Leoné Mulder 0836633002 Or e-mail to angoramtb@gmaiil.com