Bed race | Entry Form

Please do a seperate registration for each different delivery address.
Cost Of Bed ( x1 ) : R 3 800.00 The 1^st 40 entrants paid before 31st May 2012 will pay R 3 500.00 per bed

Quantity of beds *	:
Organization or Company Name *	:
Your Name *	:
Department *	:
Company Physical Address *	:


Email *	:
Work Phone	:
Cell Phone *	:
Fax	:
Your Team Name(s)*	:
If you would like to challenge another company, provide details here:	:
Additional info/Payment Terms	:
(5 T-Shirts per team entered)
Small T-shirts:	:
Medium T-Shirts:	:
Large T-Shirts:	:
X-Large T-Shirts:	:
When would you like your bed delivered?	:
Please note: Bed will only be delivered on confirmation of payment in full*.

*Easy monthly payment terms are available

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