• Entry Form

Lante 6-15 Entry Form

Name*

First
Last
Which city are you based in?*
Email*
Date of birth
Gender
Cell Number
Fax Number
Medical Aid Number
Which distance will you be running/walking?*
Which event are you attending?*
Choose entry fee*
Shirt Size (inclusive of all entry fees)*
How many people will you be refering?
What are their contact details?
How will you be paying for the entry fee? N.B. *
Please make all transfers to. Lante Investment
Holdings, FNB Sandton Branch. Branch Code 254605.
Account Number: 62174501645 *
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