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Please do a seperate registration for each different delivery address.

Cost Of Bed ( x1 ) : R 3 800.00

The 1st 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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