EmailMe Form - Alps 2 Ocean Charity Ride

Team Name *
Every indivdual must register separately. Please ensure all members use the same team name.
Individual Name *
First Last
Email *
Mobile Phone *
Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region
Age *
Charity *
St John New Zealand
Other
The charity money raised (excluding registration fee) will be split between Alps 2 Ocean and a nominated charity. The default charity is St. John (they provide rescue services for the Alps 2 Ocean Cycle Trail). Please specify if you would like to nominate a different charity for your team. Only one charity per team.
Starting Point *
Do you require a tent site? *
Yes
No
Do you have any medical conditions which may affect you during participation of this event?
Emergency Contact Name *
First Last
Emergency Contact Phone *