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Pedalyak Registration
Name
*
First
Last
Email
*
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Please enter your phone number in the country field. We'll assume you're in Australia, we'd really like your phone number and we are short of form space :)
Will you walk, run, cycle or kayak?
*
walk 7k
walk 14k
run 7k
run 14k
cycle 7k
cycle 14k
kayak 14k
Please tell us your Date Of Birth, Gender, name and phone number of an emergency contact, your sponsorship target and how you will pay your registration fee ($10 ind. or $20 a family)
*
Options to pay are cheque, direct deposit, online donation or cash on the day - see the details on the Donate! page link. By submitting this form, you agree to the conditions of entry available on the PedalYak for Samoa link on this website. If you are under 18, and your parent/carer is not participating, please provide their contact details also. If you are entering as a family, just list everyone else's names, DOB, and whether they are cycling, walking, kayaking or running in this box also.
Submit
Home
#BNYGBlog
About Us
Contact Us
Events
Mission Projects
Updates Archive
Pedalyak
PedalYak Sponsors