< ITU > Cobbled Together

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Team name   First name   Last name   Email address   Year of birth 01    01       YYYY 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 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 1923 1922 1921 1920    Phone #   Address   Emergency contact name   Emergency phone #   Country   Category Choose one Cycling No Cycling   Event entry fee 2500.00 NZD

Have you cycled 100k+ over multiple days before?  * NoYes   Have you cycled in a bunch of 4 people or more?  * NoYes   Please select an average speed you can comfortably maintain 20 23 25 27 30 Do you have any medical conditions we need to know about?  * NoYes   If Yes, clearly list any conditions or treatments

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Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver I hereby take action for myself, my executors, administrators, heirs, next of kin, successors and assign as follows: I hereby waive, release and discharge any kind of liability for death, disability, personal injury, property damage, property theft and all other foreseeable risks, claims or actions of any kind (including negligence) whatever and however occurring which may arise, at any time, as a result of or in connection with, directly or indirectly, my participation in or my travelling to and from this event, the following people or entities: Alto Cycle Tours, land managers and/or owners, their agents, event sponsors, and volunteers. I hereby indemnify and hold harmless the persons or entities mentioned above from any liabilities, claims or actions (including negligence), whatever or however caused which may arise, at any time as a result of or in connection with, directly or indirectly, my participant in or my travelling to or from this event. If for any reason Alto Cycle Tours is liable to the entrant in contract, tort or otherwise, the combined maximum liability of Alto Cycle Tours shall be limited to a sum equal to twice the entry fee paid by the entrant for this event. I accept the terms of the waiver