q4q booking form 2017 - raw

foleyg

Durbs to JHB in the Dirt 2017 – ONLY ONE WAY THIS YEAR

Fantastic fun for a great cause!!

DATES:

Kicks off From Sugar Rush in Ballito 5th October 2017. Check in on the 4 th from 2.

Arrives back at Carnival on the 8th of October.

Dirtbikes, Adventure bikes, Side-By-Sides, Rallye Bikes and Quads all riding for QASA.

Four days of riding through three Provinces:

A unique South African Adventure…

This is a real adventure – the biggest off road ride of its kind in the world.

You ride in the dirt all the way from Durban to JHB. No loading and towing.

Just on 1000 kays 1 way in the dirt for QASA.

LEKKER fun with lots of interesting sections.

We will take you to places that most people who live in SA will never get to see.

The ride changes every day.

For 2017 we have a few sections that have not been ridden before.

“From the rolling hills of KZN, to thick indigenous forests to rocky mountain passes, dams,

rivers and beautiful farmlands, you will see it all.”

Approx 250 kays of riding per day… and the terrain changes all the time.

All marked so you can relax and ride at your own pace.

All The Good stuff that you need to know:

Fund raising: This is actually what the ride is all about:

Guys and Gals, we are starting early this year to see if we can raise some much needed

funds for QASA, The Quadpara Association Of SA, but we need your help…

Please check out the attached event proposal and see where you can assist.

Thanks to all the guys who are on board so far…


QASA will issue a Section 18A Tax Exemption Certificate for corporate donations directly to

QASA. (NOT FOR ENTRY FEES).

Entry Fees:

Riders R4150.00 pp. (If you are a passenger in a sxs, or on a quad you are a rider).

Backups: R3150.00 pp. (A backup is a person in a car on the tar).

Babies and small kids 8 and under are free. This excludes a goody bag and tee shirt.

(If you want a tee shirt for the little guys they will be on sale at registration – R120 per

shirt.)

Riders and backups, your entry Fee includes:

All meals and camping (own tents).

Paramedics and medical backup.

A huge backup truck by EPS Courier Services.

A commemorative tee shirt and goody bag.

A substantial donation to QASA – the beneficiaries of the event.

YOU HAVE TO HAVE A BACKUP DRIVER FOR THIS EVENT.

We do supply backups and marshals, and EPS courier Services sends along a big truck to

help out… BUT you have to have someone along with a bakkie or trailer.

If you do break down, they can get you loaded and sorted.

If you cannot find a backup driver – please go on to our Event

Facebook page, say hello and chat to other people with the same problem.

www.facebook.com/quadsforquads/

Backup vehicles are not on the same trail as the bikes – they meet us all along the

route.

Fuel stops all the way – about 100 kilometres between each stop…


You have to attend the pre-ride briefing and registration at Sugarrush

on Wednesday afternoon.

Tee-shirts and goody bags will not be handed out on the morning of departure.

Briefing and Registration: Sugar Rush Adventure Park Wednesday 4th October2017.

Check in from 2 till 7.

Kick-off: from Sugarrush Thurs 5th October 2017 around 9am.

Arrive at Carnival City: JHB on Sun 8th October 2017.

Accommodation etc:

We arrange camping facilities, toilets and hot showers all through the event. Camping is

included, bring your own tent. If you don’t want to camp, please see the list of places to

stay for your own account.

You need to book your own accommodation on the 4th October (Wed) in Ballito. Or you

can camp at the venue.

You also need to book accommodation on Sunday the 8th of Oct in JHB if you are sleeping

over before going home.

Accommodation along the way: If you don’t want to camp…

These are the numbers to call for accommodation en route:

Weenen (5 th October up-run) Laura: 0824923665 (036)3541147

Philippa 0825075509. 0842444408.

Newcastle (6th Oct up) Majuba Lodge (034) 315-5011

Standerton (7th Oct up) Hostel. Mev Butler: (017) 712-2345

JHB accommodation close to start:

Kopanong Hotel (011) 749-0000 ½ hr from start.

Medley House (011) 740-1272. 10 mins.

Road lodge at Carnival: (011) 898-7456/7577. Carnival Hotel (011) 898-7106

Even more info:

There is limited space on the truck for bikes and quads needing to get down to Durban.

The cost is R1000 for a bike or quad, R1 500 for a side by side (Rhino). First come first

served. PAID UP FRONT WHEN YOU BOOK YOUR BIKE –

Please call Anette for details and don’t fight with her if the truck is full.

Adventure and Dual Sport Riders:

Adventures, Triumph XCs, KLRs, XTs etc.

We do realize that most of you do not want to break your bikes, or bodies on the rocks.

We will mark separate, easier trails for you on the really tricky bits.

Come and join the fun.

This is a great adventure:


You are welcome to party – but please have respect for the people around you.

THERE IS NO BOOZE ALLOWED ON THE TRAIL.

Alcohol is banned on the trail – QASA does not need new members.

Workshop: Is generally quite limited. Please get your machine properly serviced before the

event. Bring emergency breakdown parts.

This is a charity event – PLEASE - don’t sneak on without paying.

Don’t embarrass us or yourselves:

THIS IS GOING TO BE HUGE FUN - LETS MAKE A DIFFERENCE…

Feel free to mail us with any queries. Anette.acc@mweb.co.za foleyg@mweb.co.za

How you book in four easy steps.

1) Fill in your booking form: Please use a black pen, write neatly and fill in every question.

Make double sure that your email address is legible, this is how we keep in touch with you.

BLOCK LETTERS PLEASE!

2) Deposit a minimum of 50% to secure your booking. See banking details at the end of the

booking form.

Ref on Deposit slip - name and surname - Q4Q (Not just Piet, John or Sipho)

3) Fill in the medical forms (at the bottom of this lot) neatly in black.

Booking forms without medical details will not be processed.

4) Send your completed booking form, Medical form and deposit slip to:

anette.acc@meb.co.za FAX to 086-238-2728

OR: familyadventures@mweb.co.za Fax to 086-541-1390

No Team Bookings: 1 booking form for each person please…

There is also a Medical Information Form – Pages 2 and 3.

Everyone must complete pages 2 and 3.

One booking per person whether you ride or if you are doing backup in a bakkie or car.

Kids 8 and under too please – we need everyone’s details.

If you are paying for more than 1 person or for a team:

Please send a breakdown of names of the participants on a separate sheet with the

deposit slip: Team Eishkom – Riders: Jon Bon Jovi, Mary J Bligh, Christina

Aguwhatchoomacallit. Backup Driver: Ozzy Osborne. 3 shirts paid for. UP Run.


Within a couple of days, we will send a short confirmation letter to tell you that we have

received your booking forms…

Confirmation of your bookings with a list of what you need to take and all sorts of other

useful info will be sent out two weeks before the ride. In the meantime, start stocking up

on parts like tubes, tyres, levers, cables etc. refer to your whats happening with Q4Q form

attached to this email.

EVENT RIDING SHIRTS WILL ONLY BE ORDERED IF PAID IN FULL…

Details are on the booking forms.

When the artwork is ready, we’ll post the shirt design up on our facebook and website

pages. Always a very cool keepsake.

Please note that your booking will only be processed upon receipt of all of the following:

Booking Form, Medical Forms (page 2 and 3).

A Deposit slip.

PLEASE WRITE NEATLY!

Especially your email address – this is like bush telegraph – the easiest way for us to keep in

touch…

If you have any questions, please drop us a mail at:

foleyg@mweb.co.za / familyadventures@mweb.co.za

Or phone (011) 979-0053 / (011) 979-5035

We will eventually get back to you… promise!!


BOOKING FORM Durbs 2 JHB in the dirt 2017

Page 1

Check in and Briefing wed 4 th October between 2 and 7.

Leaves DBN (Sugar Rush) on Thursday 5th Oct 2017.

Arrives JHB (Carnival City) on Sunday 8th Oct 2017.

Riders all ages R4150.00

All Backups over 8 years old R3150.00pp. Kids 8 and under not riding free.

Please fill this out – 1 form per rider. 1 form per backup person.

Fax/email it along with your deposit slip and medical form to: 086-238 2728

or email to familyadventures@mweb.co.za or anette.acc@mweb.co.za

Please write neatly – block letters for the email address.

First Name:…………………………………………………. Surname:…………………………………………………….

Are you a rider or backup? (write answer)……………………………………………………………………………

Rider: Who is your backup? (state name)……………………………………………………………………………..

Backup: Who is/are your rider/s? (state names)…………………………………………………………………..

T-shirt size: (included in your package – no charge) S M L XL XXL XXXL 4XL 5XL:……………………

Any Queries:………………………………………………………………………………………………………………………….

Make and model of bike: (ie Suzuki RMX 450)………………………………………………………………………

Would you like a 2017 Riding shirt? (Please Circle) R450.00 Y…….N…….

Size: S. M. L. XL. 2XL. 3XL. 4XL. 5XL

Optional riding shirts will not be ordered if not paid in full.

Mobile number:………………………………………Landline Number:……………………………………………..

Fax:…………………………………………………………. Email:…………………………………………………………………

What reference did you use on your deposit slip:……………………………………………………….

A 50% DEPOSIT IS NEEDED TO SECURE YOUR BOOKING.

THE BALANCE IS DUE NO LATER THAN 16th September 2017

No Verbal Bookings!!!!

Bank Details: This is the only account to be used:

Family Adventures Quads 4 Quads

Standard Bank Festival Mall

Current account: 01 249 9447

Branch code 012442

USE YOUR NAME & SURNAME AND Q4Q


Page 2: Medical Forms: COMPULSARY with each booking form.

Your booking will not be captured if not filled in.

Complete this form and fax or email with your booking form and deposit slip to

086-238 2728. anette.acc@mweb.co.za

No rider will be allowed to participate in the event without filling in these

forms. Please write neatly – get your better half to fill it out if your writing is

anything like ours. One form to be filled in per rider. One per back up driver.

Full Name:…………………………………………………………… Date of Birth:……………………………………….

ID Number: …………………………………………………………………Sex:…….M…… F……..(circle)

Emergency contact Name:……………………………………………………………………………………

Emergency contact number:…………………………………………………………………………………

Your Current Personal Medical Information:

Blood Group…………………………………… Your Medical Aid Scheme:…………………………………………

Membership No: ……………………………………………........... No medical aid (please tick)………………

Allergies to Drugs/Medications:

None (Please Tick)……………… Antibiotics (specify): …………………………………………………………

Narcotics (specify): ………………………………….......... Aspirin…………. Medical/X-Ray Dye……………

Other Allergies (please specify)……………………………………………………………………………………………

Medications (Prescription or over-the-counter): (please tick)

None…………. Antibiotics (specify): ……………………………………………

Aspirin……………… Digitalis/Digoxin.................. Insulin………………… Nitroglycerin(TNT)……….

Narcotics (specify)……………………………...……………………………………………………………………………….

Steroids (specify)……………………………………………………………………………………................................

Lasix ……… Phenobarbital……… Other…………. (Specify)…………………………………………………………..


Page 3: Previous Medical History – please tick:

No Past Medical Problems………. Diabetes……….. Immune System Disorder……….. Abnormal

Electrocardiogram………. Emphysema……………….. Asthma or Lung Disease……………, Seizure

or Epilepsy………………………….., Heart Attack or Angina……………. Stroke or Brain

Haemorrhage……………….. Bleeding Disorder………………………. Hepatitis…………………

Other:

…………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………..

Previous Surgery/Procedures: Please tick

None…………. Appendectomy……………………..Gallbladder Removal ………………….

Joint Replacement……………………………. Angioplasty……………. Cardiac Bypass…………………..

Hysterectomy…………………… Valve Replacement…………………….

Other procedures relevant to this event (please specify):

………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………..

…………………………………………………………………………………………………………………………..

Medical Devices:

None……..Contact Lenses……..Hearing Aid……..Joint Replacement……..

Artificial Heart Valve…….. Dialysis…….. Shunt IV Line/Shunt…….. Pacemaker……..

Automatic Internal Defibrillator…….. Gastrostomy Tube……..

Other (please specify and attach relevant documentation)

………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………

………………………………………………………………………………………………………………………………………………

Please mail this form with your booking form and deposit slip to:

www.adventurecompany.co.za

anette.acc@mweb.co.za

All of our details:

Tel: (011) 979-0053 (011) 979-5035. Anette 083-314-2203. Corrine 082-870-6134.

Glenn 072-177-0621

foleyg@mweb.co.za anette.acc@mweb.co.za

Facebook page: www.facebook.com/familyadventuressa

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