Dream Riders Registration Form
2024
Please complete all the fields below so that we can ensure that you are registered as a Dream Rider for 2024
Your Name
*
Mr.
Mrs.
Miss.
Prefix
First Name
Last Name
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Gender
*
Female
Male
What size sox do you need?
*
Medium
Large
Will you be joining us in the hospitality tent after the race?
*
Yes
No
Cycling Shirt size
*
Xsmall
Small
Medium
Large
X Large
2XL
3XL
4XL
Please choose your prefered entry
*
Please Select
R 2000 (including cycling shirt, kit and hospitality access)
R 2500 (including cycling shirt, kit, hospitality access and 947 cycle entry)
Choose your payment method below
*
Credit Card
EFT ( banking details at bottom of form)
For Credit Card payments:
prev
next
( X )
x1 Cycle shirt, kit and hospitality only
2,000.00
ZAR
Quantity
1
2
3
4
5
6
7
8
9
10
x1 Cycle shirt, kit, hospitality and 947 entry only
2,500.00
ZAR
Quantity
1
2
3
4
5
6
7
8
9
10
Permission for Reach For A Dream Foundation to use your photos taken at the event for marketing and social media channels
*
Yes
No
How did you hear about us
*
Sales Agent
Social Media
Google Ads
Newsletter
Marketing ( advert, newspaper, online advert)
Other
Would you like to be updated about the upcoming events?
*
Yes
No
Submit
Should be Empty: