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: 19 DEC 2021)

IMPORTANT:

PLEASE COMPLETE THIS ONLINE APPLICATION IN FULL, WHICH INCLUDES EVERY PAGE. ON THE LAST PAGE THE SUBMIT BUTTON NEEDS TO BE CLICKED ON, TO ENSURE THAT THE APPLICATION HAS BEEN LOADED AND SENT SUCCESSFULLY. FAILING THIS, YOUR APPLICATION WILL NOT BE SUBMITTED TO THE ENTRY ADMINISTRATOR.
  • 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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