Mpatlise | Mosisedi Fitness Extravaganza 2026

SECTION 1: PERSONAL DETAILS

Full Name *

ID / Passport Number *

Date of Birth * (DD/MM/YYYY)

Gender *

Contact Number *

Email Address

Residential Village / Town *

SECTION 2: ACTIVITY SELECTION

Select ONE activity: *

5KM Run - P150 10KM Run - P200 Road Cycling - P150 Off-Road Cycling - P200 Sunrise Yoga - P150

Age Category *

T-Shirt Size

SECTION 3: EMERGENCY & MEDICAL

Emergency Contact Name *

Emergency Contact Number *

Do you have any known medical conditions? *

Yes No

Medical Conditions:

Current Medications:

Allergies:

SECTION 4: INDEMNITY & WAIVER

I confirm that my participation is voluntary and at my own risk.

I acknowledge organisers are not liable for injury, loss, or damage.

I confirm I am medically fit to participate.

I agree to follow all event rules.

I consent to photos/videos for promotional use.

Date * (DD/MM/YYYY)

For Participants Under 18 Years - Parent / Guardian

These fields are REQUIRED if participant is under 18 years of age

Parent/Guardian Full Name

Relationship

Guardian Contact

ID Number

Date (DD/MM/YYYY)

SECTION 5: PARTICIPANT DECLARATION

I am medically fit and able to participate. All information is true and correct. I agree to abide by event rules. I understand organisers may withdraw participation if unfit.

Full Name (declaration)

Date (DD/MM/YYYY)

MOSISEDI FITNESS EXTRAVAGANZA 2026

SECTION 1: PERSONAL DETAILS

SECTION 2: ACTIVITY SELECTION

SECTION 3: EMERGENCY & MEDICAL

SECTION 4: INDEMNITY & WAIVER

For Participants Under 18 Years - Parent / Guardian

SECTION 5: PARTICIPANT DECLARATION

?? ADMIN PORTAL

MOSISEDI FITNESS EXTRAVAGANZA 2026

SECTION 1: PERSONAL DETAILS

SECTION 2: ACTIVITY SELECTION

SECTION 3: EMERGENCY & MEDICAL

SECTION 4: INDEMNITY & WAIVER

For Participants Under 18 Years - Parent / Guardian

SECTION 5: PARTICIPANT DECLARATION

?? ADMIN PORTAL

Admin Login

Payment Verification