Kalahari Augrabies Extreme Marathon Registration Form 2019 To register for KAEM 2019, complete the form below and submit. First name: (required) Surname: (required) Email: (required) Date of birth: (required) Age: (required) ID / Passport number: (required) NB: Add a copy of your passport or South African ID document with your registration form (PDF/JPG/PNG formats). Physical (residential) address: (required) Telephone numbers (country code) Mobile:(required) Work:(required) Home:(required) Email:(required) For South African participants it is compulsory to have medical cover which includes taking part in KAEM. If you currently do not have medical cover and wish to compete in KAEM 2019, please tick the box below. I do not have medical cover Medical aid name: Medical aid number: Medical aid telephone number: Main member: Main member telephone number:: For International participants it is compulsory to have travel insurance with medical cover which includes taking part in KAEM.If you currently do not have such travel insurance and wish to compete in KAEM 2019, please tick the box below. I do not have travel insurance with medical aid. Travel insurance name: Travel insurance number: Travel insurance telephone number: In the event of an emergency, please contact: Name & Surname: Telephone number: Email: Event Fee priced in ZAR I AGREE to Price - ZAR 27,750 Additional Options; please tick what is required. YES I need transfer: Upington/Augrabies – ZAR 300 YES I need transfer: Augrabies/Upington – ZAR 300 Please acknowledge and tick the following: AGREE - I acknowledge that I am aware that the Kalahari Augrabies Extreme Marathon is an extreme event and accordingly a potentially dangerous activity. Although stringent safety measures will be in place, the risk of personal accident or injury cannot be completely excluded. I confirm that I am physically and mentally well and fit and am able to participate in exercise of this nature without undue risk to my health. AGREE - I hereby undertake and agree to indemnify and hold harmless all land owners, Augrabies Extreme Marathon cc, its’ employees, volunteer helpers, sponsors and agents against any liability and against any/all proceedings, claims, damages, interest, costs, and/or expenses which may result from any accident or injury to myself or my belongings. AGREE - I grant my permission to use my name, race information and photographs, video tapes, broadcasts and telecasts in which I may appear, free of charge. I confirm having read and fully understood the Rules and accepted the “Terms and Conditions” of this contract as more fully set out in Conditions of Contract (www.kaem.co.za). AGREE - I consent to undergoing a pre-race medical examination* and to having a tetanus vaccination as a condition of entry. I understand that a failure or refusal to do so will disqualify me from participation in the Kalahari Augrabies Extreme Marathon. Medical forms to be completed by your doctor will be available from 01 August 2019. The medical form must be emailed or faxed to the organizers no later than 15 September 2019. AGREE - I confirm that I am aware that a refusal to cooperate with the reasonable instructions of the race doctor or medical personnel to accept medical intervention or to retire from the race will result in my immediate disqualification and will relieve the organizers of any/all responsibility for my well being. PLEASE NOTE: An original registration form is required to be signed at REGISTRATION.