Assegaaimc

Please select Race: *

ID no: *

Age: *

Name: *

Surname: *

Club Name: *

License No: *

Gender: *

Male

Female

Category: *

T-Shirt Size: *

T-shirts only for first 75 pre-entrants on the 42 KM

Tel no: *

Fax no: *

E-Mail: *

Address: *

I subject myself to the rules and regulations of ASA and the IAAF. *

Yes

Temp License number is compulsory and sold for R25: if you do not have a 2015 license no

EFT Payments can be made into the Assegaai Marathon Club Account as follow:

ABSA 4052670065,Piet Retief Branch, 334544

Please use your ID number as reference no :

Mail proof to assegaaimk@gmail.com or fax to 017 826 3313

alternatively pay on race day if no proof is supplied