Payment Methods

* IMPORTANT - please make sure that you read the entire form carefully before entering any details. The procedure is slightly different depending on your preferred payment method. Please refer to the table below:

Cheque Payment

If paying by cheque, enter the details into the form below and print off. Please ensure you sign the form and send it together with a cheque to:

Adventure Racing Coromandel
PO Box 79
Coromandel
New Zealand

Internet Banking Payment

If paying by internet banking, please enter your details into the below form and submit the entry form.
Please ensure that you tick the checkbox indicating that you accept the terms and conditions.

Once the form has been submitted sucessfully, please deposit the Total Payment amount into this bank account:

020304-0337227-000
Payee name : ARC

Please ensure that you include your name and the race name in the transaction.
The Team Captain will receive an email copy of your entry form data for the Team's own records.

Credit Card Payment

If paying by credit card, please click on one of the links below:

K1 Entry Form
K2 Entry Form
1/4K Entry Form

Race

Race:

K2 Elite

K2

Pearl Izumi K1

Quarter K

Race Categories

Class (Use age on race day):

Class Type:

Men

Women

Mixed

Race Category:

Solo

Tandem

Team of 4

Team of 2

Licence Number (Elite riders only):

Team Name/School:

Team Captain or Solo Competitor

Team Captain / Solo Name:

Team Captain / Solo Address:

Team Captain / Solo Email:

Team Captain / Solo Age:

Team Captain / Solo Sex:

Team Captain / Solo Fee:

$

Team Member 2

Team/Group Member 2 Name:

Team/Group Member 2 Address:

Team/Group Member 2 Email:

Team/Group Member 2 Age:

Team/Group Member 2 Sex:

Team/Group Member 2 Fee:

$

Team Member 3

Team/Group Member 3 Name:

Team/Group Member 3 Address:

Team/Group Member 3 Email:

Team/Group Member 3 Age:

Team/Group Member 3 Sex:

Team/Group Member 3 Fee:

$

Team Member 4

Team/Group Member 4 Name:

Team/Group Member 4 Address:

Team/Group Member 4 Email:

Team/Group Member 4 Age:

Team/Group Member 4 Sex:

Team/Group Member 4 Fee:

$

Team Member 5

Team/Group Member 5 Name:

Team/Group Member 5 Address:

Team/Group Member 5 Email:

Team/Group Member 5 Age:

Team/Group Member 5 Sex:

Team/Group Member 5 Fee:

$

Entry Fees

	K2/K2 Elite		Pearl Izumi K1		Quarter K
	Team $	Each $	Team $	Each $	Each $
Solo Rider	-	95	-	75	55
Tandem Team	110	55	85	42.50	65
Junior (Under 19)	-	50	-	40	30
Team of 4	300	75	-	-	-
Team of 2	150	75	120	60	-
Junior team of 4	150	37.5	-	-	-
Junior team of 2	75	37.5	60	30	-

Early Entries

$10 discount per Person and $10 discount on race shirt if entries received before 31st July 2007

Late Entries

$15 extra per Person if entries received after Sunday 14th October 2007

Group Entries - Special Arrangement

Enter a group of 5 individual riders together and the 5th person is free. Entry and payment must be together at the same time.

Entries Close

Entries close Wednesday 24th October 2007

Spirit of Coromandel Trust

$5 from every entry is paid into the Spirit of Coromandel Trust which has been established to encourage local people, particularly youngsters, into sporting and outdoor activities.

Cancellation of Entry

Cancellations of entry prior to 14th October 2007 will be able to transfer the entry fee to any other ARC event, or be repaid less a $15 cancellation fee.

Official Race Tee Shirts

$25 each (Indicate quantity)

Race Tee Mens S:

Race Tee Mens M:

Race Tee Mens L:

Race Tee Mens XL:

Race Tee Mens XXL:

Race Tee Womens 8:

Race Tee Womens 10:

Race Tee Womens 12:

Race Tee Womens 14:

Race Tee Womens 16:

Total Race Tee Payment [= B]:

$

Bus Travel

(Indicate quantity)

Pearl Izumi K1-Thames-Whitianga @ $25 each:

Quarter K-Thames-Coromandel @ $20 each:

Total Bus Payment Amount [= C]:

$

Payment Calculations / Details

Currency is in NZ Dollars

Total Entry Fees [A]:

$

Total Race Tees Payment [B]:

$

Total Bus Travel Payment [C]:

$

Add Late Entry Fees [D]:

$

Less Early Entry Fee [E]:

$

Total Payment Enclosed [A + B + C + D - E]:

$

Team Captain's Declaration

I/We agree to enter this event at our own risk. I/we accept that road cycling involves a real risk of serious injury or even death from various causes including accidents with other competitors or road users, course of weather conditions, equipment failure, dehydration or over exertion and other causes. By competing in this event, I/we accept all risks necessarily flowing from my/our participation in the event. Accordingly I release all persons or organisations associated directly or indirectly with the running of the event from all claims or demands and proceedings arising out of my/our participation and I hereby indemnify them against all liability (including liability for their negligence and the negligence of others) for all injury, loss or damage arising out of or connected with my participation in this event. This release shall extend to and include Adventure Racing Coromandel (ARC) and their respective directors, partners, managers, officers, agents, contractors, employees and volunteers including medical and paramedical personnel appointed for the event, the owners, licensees and occupiers of land upon which the event or any part of it is conducted, any statutory body or local authority having control over any land upon which the event or any part of it is conducted or which is involved directly or indirectly with the event in any manner whatsoever and promoters, sponsors and event organisers. I/We have read and understood the event rules and will abide by the decision of the race director in any and all matters. I consent to receiving any medical treatment that the event organisers think desirable during or after the event. Safety precautions undertaken by organisers (such as course supervision, and race safety briefings) are a service to me and other competitors but are not a guarantee of safety.

I/We agree that ARC and any sponsor of this event may use information contained in this form for purposes connected with the event, and to provide me/us with details of other products, services and events from time to time. I/We authorise ARC to disclose information to any sponsor of this event for such purposes. I/We understand that we have rights under the Privacy Act 1993 to access and correct any information held about me/us.

If the event is cancelled due to flood, cyclone, torrential rains or other 'acts of God' conditions, I understand that entry fee will not be refunded. My registration is not transferable to other people. If the event is cancelled, my registration fee is non-refundable.

Please Indicate your agreement to the above Terms & Conditions :

Team Captain/Individual Signature:

Date:

/ /

Please tick this box if you do not want to receive any info from our sponsors: