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

Click here for a printable PDF ENTRY FORM

If paying by cheque, please download the printable blank version of this entry form above, complete the details and send it together with your 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

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 the link below

Race

Race:

Epic

Challenge

Apprentice

Race Categories

Class:

Race Category:

Team Name:

Team Captain or Solo Competitor

Team Captain / Individual Name:

Team Captain / Individual Address:

Team Captain / Individual Phone:

Team Captain / Individual Email:

Team Captain / Individual Age:

Team Captain / Individual Sex:

Team Captain / Individual Fee:

$

Team Member 2

Team Member 2 Name:

Team Member 2 Address:

Team Member 2 Phone:

Team Member 2 Email:

Team Member 2 Age:

Team Member 2 Sex:

Team Member 2 Fee:

$

Team Member 3

Team Member 3 Name:

Team Member 3 Address:

Team Member 3 Phone:

Team Member 3 Email:

Team Member 3 Age:

Team Member 3 Sex:

Team Member 3 Fee:

$

Team Member 4

Team Member 4 Name:

Team Member 4 Address:

Team Member 4 Phone:

Team Member 4 Email:

Team Member 4 Age:

Team Member 4 Sex:

Team Member 4 Fee:

$

Team Member 5

Team Member 5 Name:

Team Member 5 Address:

Team Member 5 Phone:

Team Member 5 Email:

Team Member 5 Age:

Team Member 5 Sex:

Team Member 5 Fee:

$

Entry Fees

	Epic $	Challenge $	Apprentice $
Solo Riders/Teams Per Person	70	60	50
Juniors	35	30	25
Relay Teams - Per Team	130	110	-
Relay Teams - Per Person	65	55	-

Please make cheques payable to Adventure Racing Coromandel (ARC)

Early Entries

Entries received prior to 31st October 2006 can deduct $10 of their entry fee and $10 of their race shirt

Late Entries

Entries received after 13th January 2007 should add $15 per person

Group Entries

Groups of 5 or more will receive one free entry into the event

Number In Group:

Official Race Shirts

100% Cotton, Black/Orange $25 each. Please indicate quantity required

Mens Tees

Quantity - Mens Tee S:

Quantity - Mens Tee M:

Quantity - Mens Tee L:

Quantity - Mens Tee XL:

Quantity - Mens Tee XXL:

Total number of Mens Tees required:

Womens Tees

Quantity - Womens Tee 8:

Quantity - Womens Tee 10:

Quantity - Womens Tee 12:

Quantity - Womens Tee 14:

Quantity - Womens Tee 16:

Total number of Womens Tees required:

Total Tee Payment Amount @ $25 per shirt [= B]:

$

Payment Calculations / Details

Total Entry Fee [A]:

$

Total Race Products Payment [B]:

$

Total Late Entry Fees [C]:

$

Total Early Entry Discount [D]:

$

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

$

Team Captain's Declaration

I/we agree to enter this event at our own risk.
I/we accept that trail and mountain biking involves risk and will not hold the event organisers, officials, sponsors, or any other person involved with the event liable for any loss or injury to person or equipment incurred during the event.
I/we have read and understand the event rules and will abide by the decision of the race director in any and all matters.
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.
I/we acknowledge that only the courts of New Zealand shall have jurisdiction to entertain any complaint, demand, claim or cause of action whether based upon alleged breach of contract or alleged negligence arising from the treatment I may receive.
I/we hereby agree that if I/we commence any legal proceedings, I/we will commence such legal proceedings in New Zealand and only in New Zealand and I/we hereby submit to the jurisdiction of the courts in New Zealand.

Please Indicate your agreement to the above Terms & Conditions :

Competitor Signature:

Competitor Name:

Date:

/ /

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