The Crank Entry Form

Please refer to the event website for detailed event information www.thecrank.co.nz

As manager you will be emailed a team sheet to fill out. We require the team sheet filled out a week before the event on 21st September 2012. Please email the list back with the riding order of individual team members.

If changes need to be made after this date, we ask you bring this list filled out to the Registration/ Bag Pick up, 4pm – 7pm September 27th, The Cloud.

For flexi payment options or to be invoiced please call 0800 CANTEEN or email info@thecrank.co.nz

Crank Registration

Test

Entry Form

1. Team Name: Prize for Best Team Name Please enter your Team Name
2. Organisation: Please enter your Organisation
3. Manager: Please enter your Manager
4. Address: Please enter your Address
5. Phone: Please enter your Phone Number
6. Mobile:
7. Email: Please enter your Email Address Your Email Address is invalid
8. Date of Birth: --- Day --- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 --- Month --- January February March April May June July August September October November December --- Year --- 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 Please enter a Day for your DOB Please enter a Month for your DOB Please enter a Year for your DOB Please enter a valid Date

Test

Grades & Fees

1. Team Type: --- Team Type --- 12 hours RPM® bike $420 (6 to 12 riders) 12 hours wind trainer $420 (6 to 12 riders) 6 hours RPM® bike $210 (3 to 6 riders) 50 teams maximum 6 hours wind trainer $210 (3 to 6 riders) 50 teams maximum 12 hour enduro wind trainer $420 (2 to 4 riders) 12 hour enduro RPM® bike $420 (4 riders) 1 hour solos $35 (1 rider / 1 hour) Please select a Team Type

I have read and agree to the Terms & Conditions Please accept the Terms and Conditions

In consideration for acceptance of our entry, I agree on behalf of my team to comply with the rules of the The Crank 2012 and confi rm that we intend to compete entirely at our own risk. To the extent permitted by law, we agree that no one involved in the event (including, but not limited to, event directors, officers, sponsors, volunteer groups or other individuals) will be liable to us in any way whatsoever for any injury, loss or damage suffered during the event however it occurs (including caused by negligence). We release and discharge those people from all claims, liability, loss or damage arising in connection with the event.

Click here to become a CanTeen supporter. twitter is currently sleeping. Follow us on Twitter

Premier Partner Pams

• Contact Us
• Privacy Policy
• Access Keys
• Site Map
• Web Design by Terabyte

CanTeen supports young people living with cancer. These are the values we live by.