6-8 December 2013 Kroonpark Holiday Resort, Kroonstad
Pre-paid entries – First 1000 entries only! Closing date: 06 October 2013
Entrance Fee : R250-00 X:________ = R__________ Includes: Metal, Cloth badge and
a 200ml Poison Potion
T-Shirts : R70-00 X:________ = R__________ Size(XXXL – S) :___________
Woman vest : R100-00 X:________ = R__________ Size(XL – S) :___________
Caps : R60-00 X :_______ = R__________
5-Year Badge : R20-00 X :_______ = R__________
10-Year Badge : R20-00 X :_______ = R__________
15-Year Badge : R20-00 X :_______ = R__________ TOTAL:
Poison Rally Belt Buckle FREE to First 1000 pre-paid entries
Closing date: 06 October 2013 (PRE-PAIDS ONLY)
I hereby agree that I am attending the POISON RALLY 2013 at my own risk and indemnify the organisers and their agents against any damages sustained by myself as a person or belongings. I agree to behave according to the rules and instructions of the organisers and their agents. I understand the above and the instructions and the information in the entry pamphlet. I agree not to take any fire arms into the rally site and hand in all the fire arms at the gate for safe keeping.
Deposits POISON RALLY
FNB – Clearwater Mall
A/C No. 62345390489
Branch code: 250655
Ref.No. “YOUR SURNAME OR YOUR CLUB NAME”
E-mail your deposit slip & Entry Form to Admin@PoisonRally.co.za
In order for us to confirm your entry
Do not e-mail after the closing date – enter & pay at the gate.
Pre-paid entries will only be valid if you have a confirmation number.
Chalets are already fully booked.
Signature: ____________________(Rider) Signature: ______________________(Pillion)
By submitting this form, I/we accept and agree with all of the above