World Interhash 2012 Bid, Mombasa - Kenya

 
Registration Form
  1. The Great Hash Migration on 2012 Mombasa, Kenya
    18th to 20th May 2012
  2. (*) Required Fields
  3. Names(*)
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  4. Hash Name(*)
    Please Enter Hash Name
  5. Email(*)
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  6. Hash Chapter
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  7. Passport No. (or ID No.)
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  8. Date of Birth (dd.mm.yyyy)(*)
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  9. Gender(*)
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  10. Nationality(*)
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  11. ________________________________________________________
  12. Address
  13. Contact Address (Street, Town/City, State, Country, Zip/Post Code etc)
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    Street, Town/City, State, Country, Zip/Post Code etc
  14. ________________________________________________________
  15. Contact Incase of Emergency
  16. Name
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  17. Telephone
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  18. ________________________________________________________
  19. T-Shirt Size
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  20. ________________________________________________________
  21. Preferred Run





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  22. ________________________________________________________
  23. Preferred Drink



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  24. ________________________________________________________
  25. Preferred Diet


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  26. Payment: - US $175

    1. By Visa, MasterCard or American Express log on to www.wildcatssafaris.com/epay . We have partnered with Wildcats safaris owned by Kenyan hashers, to provide you with an avenue for online payment. Enter your safari as The Great Hash Migration on Registration’ on the payment form.

    2. By Telegraphic Transfer (International Wire Transfer) payable to: World Interhash 2008 Kenya. Local Kenyan bank cheques accepted.
    (All bank and transfer charges to be borne by individual hashers: Proof of transfer must accompany this form)

    Bank: CfC Stanbic Bank Limited, P O Box 30550 00100 GPO Nairobi, Kenya.
    Account No: 02-220-817838-02
    Swift Code: SBICKENXXXX


    I accept that the Organising Committee of The Great Hash Migration on 2012, the Hare(s) duly appointed by the committee, sponsors and the owners of the land and property where the run may take place will take all reasonable measures to ensure safety and well being of the participant but accept no liability for any injury, damage or loss, however these may occur. I will also not hold the committee, its members or any affiliated person(s) responsible for any accident, loss, damages or injury sustained by me before, during or after the run.

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