Kili[Man] 2011 Registration

Booking Application

Surname*

First Name*

Registration date

Postal Address

Street/house number*

Zip-Code*

City*

State

Country*

Date of birth*

Gender*

female

male

E-Mail*

Phone*

Application for challenge

Where did you hear about Kiliman?

News Paper

Magazine

Internet Portal

Radio

Flyer

Other

I confirm having read and fully understood and accepted the "Conditions of Contract and Rules of KiliMAN 2011". In signing this booking application, I hereby indemnify and hold harmless Chagga Tours and their employees and agents from all losses and injuries sustained by me. I further give permission for the free use of my name, voice or picture (still or moving) to be used in any broadcast, telecast, advertising, promotion or any other form of advertising of this and future events.

* Mandatory