EmailMe Form - Lagoon Crossing 2018 - Entry Form

Lagoon Crossing 2018 - Entry Form

Please complete one for each participant.
Entry fee of R120 payable at registration on the day of event.

Name *
First Last
Email *
Date of Birth *
MM / DD / YYYY
Cell Phone *
Hometown *
Participaiton *
Swimming
Paddling
SUP/Surfboard
Land Support
Other
Indicate if you need a paddler
Emergency Particulars:
Name *
First Last
Relationship *
Cell Phone *
Do you suffer from any allergies or medical conditions? (if YES, please elaborate) *
Other Questions:
Please indicate whether you have done Lagoon Crossing before *
2010
2011
2012
2013
2014
2015
2017
Nope, this is my first time
Do you have a Wild Card? *
Yes
No
Does you household sort domestic waste for recycling? *
Yes
No

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