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Hangana Seafood (Pty) Ltd

19 Ben Amathila Avenue


PO Box 26, Walvis Bay, Namibia
Tel: +264 64 218 400
Fax: +264 64 218 499
Email: info@hangana-hakerun.com
Web: www.hangana-hakerun.com

10 km FUN RUN - REGISTRATION FORM


(Minimum age 12)

Please ll out this registration form and email it to info@hangana-hakerun.com or fax it to +264 64 218 499

First Name

Surname

Date of Birth Age on


Gender Female Male DD MM YYYY day of race

Email

Contact No

Country Town
Address

Club

T-shirt Size S M L XL XXL Entry Fee N$100.00

Category Ladies Juniors


Ladies Open
12 - 18

Men Open Men Juniors


12 - 18

INDEMNITY: I declare that I am an amateur and that I shall participate in this race at my own risk and indemnify the
organizers and sponsors of this race against any claim whatsoever which may result from my participation.

Date Signature

I agree to receive information about the Hangana Hake Run & Ride in future. YES NO

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