Registration
1
Entry Type "Individual / Team"
2
Athlete Info
3
Supporter Info
4
Waiver and Acknowledgements
5
Confirmation Page
Knysna Extreme Registration
Unique ID
Please select your entry type
Select
Individual Entry – R4,500 (Available)
Team Entries – R6,300 (Available)
Individual Entry – R4,500
(1 Athlete + 1 Supporter)
Team Entries – R6,300
(3 Athletes + 1 Supporter)
Individual Entry
Price:
R4,500.00
Team Entry
*
Price:
R6,300.00
Additional Breakfast Ticket
*
Price:
R120.00
Note - Athlete and Supporter Breakfast Tickets included in the entry fee
How many additional breakfasts would you like?
Please enter a number less than or equal to
2
.
Subtotal
R0.00
Athlete Information
Please upload a photo of yourself.
Drop files here or
Accepted file types: jpg, gif, png, pdf.
This photo will be used in the Athlete Guide.
Discipline
*
Select
Cycle
Run
Swim
Name
*
Surname
*
Please select your club:
Select
No Club
Other
APEX Multisport
Atlantic Triathlon Club (ATC)
Cape Multisport Club (CMC)
Club 100
Cycle Lab
Dare To Tri
Embark
Kikstart Triathlon
M.A.D. Multisport
Matrix Multisport
Multi Sport Maniacs (MSM)
My Programme Generator (MPG)
My Training Day (MTD)
PEaK
Port Elizabeth City Mustangs
Pure Symmetry Multisport
Smart Tri
Stellenbosch Tri Squad
Trifactri
Troisport
Wingman
Please enter your club name
*
Gender
*
Select
Female
Male
Date of birth
*
Date Format: DD slash MM slash YYYY
ID / Passport Number
*
Contact Number
*
Contact Email
*
Nationality
*
Select
South Africa
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Shirt Size
*
Select
XS
S
M
L
XL
XXL
Medical Details
Emergency Contact Name
*
Emergency Contact Number
*
Medical Aid Provider
*
International athletes, please insert the name of your Travel Insurance Policy Provider
Medical Aid Number
*
International athletes, please insert the number of your Travel Insurance Policy
Do you have any medical conditions?
*
Select
No
Yes
Please Specify
*
Do you take any medication on a regular basis?
*
Select
No
Yes
Please Specify
*
Do you have any allergies or adverse reactions to any medication?
*
Select
No
Yes
Please Specify
*
Athlete Two Information
Please upload a photo of yourself.
Drop files here or
Accepted file types: jpg, gif, png, pdf.
This photo will be used in the Athlete Guide.
Discipline
*
Select
Cycle
Run
Swim
Name
*
Surname
*
Gender
*
Select
Female
Male
Date of birth
*
Date Format: DD slash MM slash YYYY
ID / Passport Number
*
Contact Number
*
Contact Email
*
Nationality
*
Select
South Africa
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Shirt Size
*
Select
XS
S
M
L
XL
XXL
Medical Details
Emergency Contact Name
*
Emergency Contact Number
*
Medical Aid Provider
*
International athletes, please insert the name of your Travel Insurance Policy Provider
Medical Aid Number
*
International athletes, please insert the number of your Travel Insurance Policy
Do you have any medical conditions?
*
Select
No
Yes
Please Specify
*
Do you take any medication on a regular basis?
*
Select
No
Yes
Please Specify
*
Do you have any allergies or adverse reactions to any medication?
*
Select
No
Yes
Please Specify
*
Athlete Three Information
Please upload a photo of yourself.
Drop files here or
Accepted file types: jpg, gif, png, pdf.
This photo will be used in the Athlete Guide.
Discipline
*
Select
Cycle
Run
Swim
Name
*
Surname
*
Gender
*
Select
Female
Male
Date of birth
*
Date Format: DD slash MM slash YYYY
ID / Passport Number
*
Contact Number
*
Contact Email
*
Nationality
*
Select
South Africa
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Shirt Size
*
Select
XS
S
M
L
XL
XXL
Medical Details
Emergency Contact Name
*
Emergency Contact Number
*
Medical Aid Provider
*
International athletes, please insert the name of your Travel Insurance Policy Provider
Medical Aid Number
*
International athletes, please insert the number of your Travel Insurance Policy
Do you have any medical conditions?
*
Select
No
Yes
Please Specify
*
Do you take any medication on a regular basis?
*
Select
No
Yes
Please Specify
*
Do you have any allergies or adverse reactions to any medication?
*
Select
No
Yes
Please Specify
*
Supporter Information
Name
*
Surname
*
Gender
*
Select
Female
Male
Date of birth
*
Date Format: DD slash MM slash YYYY
ID / Passport Number
*
Contact Number
*
Contact Email
*
Nationality
*
Select
South Africa
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Shirt Size
*
Select
XS
S
M
L
XL
XXL
Waiver and Acknowledgements
The following statements apply to both Athletes and Supporters.
Total
R0.00
Ultra-Distance / Extreme Triathlon
*
By ticking this box, we acknowledge that we are aware of the risks and hazards associated with participating in the Knysna Extreme Triathlon and attest that we are physically fit and able to compete in the Knysna Extreme Triathlon.
Standard Waiver
*
By ticking this box, we accept that we have read and acknowledged the Athlete and Supporter Waiver as described in the
Event Manual
.
Withdraw / Refund Policy
*
By ticking this box, we accept that we have read, understood and accepted the withdrawal policy as described in the
Event Manual
.
Pre-Race Briefing
*
By ticking this box, we acknowledge that the Pre-Race Briefing is mandatory.
Signature
*
Full name (adult registrant/parent/guardian) By way of signature above, I agree that I have read and understood all the requirements of entry into this event and declare that all information provided here is accurate and complete.
Confirmation Page
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Comments
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