Epoch Canterbury Tour Entry
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Your Date of Birth
-
Day
-
Month
Year
Date
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SECTION 2: Grade Selection
Gender/Sex
*
Male
Female
Requested Race Grade
*
Please Select
U15
U17
Women B
Women A
Men D
Men C
Men B
Men A
Grades may be combined if numbers are low. Women will always be classified separately
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SECTION 3: Emergency Contact
Emergency Contact Name
*
Emergency Contact phone
-
Area Code
Phone Number
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SECTION 4: Medical & Safety Information
Do you have any medical conditions race officials should be aware of?
*
No
yes, please Specify
Are you currently fit to compete in a multi-day road race?
Yes
No
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SECTION 5: Event Information & Acknowledgements
Please acknowledge the following:
I understand this is a multi-day stage race and all stages count toward GC
I agree to race under Cycling New Zealand rules and event regulations
I understand that race schedules may change due to weather or safety
I acknowledge that cycling is a high-risk sport and race at my own risk
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Tour Payment
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Tour entry
$
169.00
NZD
Quantity
1
2
3
4
5
6
7
8
9
10
Tour Hoodie
Premium Hoodie with full front Zip, waiting at registration for you to collect
$
90.00
NZD
Quantity
1
2
3
4
5
6
7
8
9
10
Size
XS
S
M
L
XL
Credit Card Details
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Last Name
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