DJ RALLY 2022 Entry Registration Form
DJ RALLY DATES: FRIDAY 11th MARCH to SATURDAY 12th MARCH 2021

ENTRY CLOSING DATE: 31 JANUARY 2022
SAVVA PERMIT NUMBER: P31/2021
(Online form version: 28 Oct 2021)
  • RIDER MUST COMPLETE THIS SECTION

  • Club Name
    Membership No
    Indemnity No VSR 24
  • Address Line 1
    Address Line 2
    City (and Country if not SA)
    Postal Code
  • Mobile
    Home
    Work
  • RIDER MEDICAL INFORMATION MANDATORY

  • Medical Allergies (Bee stings, foods, medication, etc)
    Current Medication (Blood pressure tablets, Asthma pumps, etc)
  • Medical Aid Company Name
    Medical Aid Number
    Medical Aid Type (Full, Comprehensive, Key Classic, etc) - Optional
  • Name and Surname
    Relationship
    Mobile No
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