2010 Entry Form 13th March 2010 Name Address Phone EMail A SEPARATE ENTRY FORM IS REQUIRED FOR EACH RIDER. KONA COLVILLE CONNECTION (72km) Open Men Veteran Men (45-54) Open Women Veteran Women (45-54) Junior Men (under 19) Super Experienced Guys (+55) Junior Women (under 19) Grande Dames (+55) Masters Men (35-44) Single Speed Masters Women (35-44)   Ground Effect 40km Junior Men (under 19) Junior Women (under 19) Men Women Veteran Men (45-54) Veteran Women (45-54) Jungle Coffee 24km Men Cool Dudes (under 16) Women Hot Chics (under 16)    YOU CAN ONLY COMPETE IN ONE DIVISION. Ages at 13th March 2010.   I Have finished all eight previous Colville Connection Rides                     (Under 16 years - Entry fee = half price) KONA COLVILLE CONNECTION 72KM   Payment received after January 31st 2010 $90.00 GROUND EFFECT40km   Payment received after the 31st of January 2010 $85.00 JUNGLE COFFEE 24km   Payment received after the 31st of January 2010 $60.00 Tasti Breakfast 1 2 3 4 5 @ $5.00 ea $ Post Event BBQ 1 2 3 4 5 @ $12.00 ea $ T SHIRTS: @ $30 EACH (white) (indicate number as appropriate) S 1 2 3 4 5    M 1 2 3 4 5     L 1 2 3 4 5    XL 1 2 3 4 5   XXL 1 2 3 4 5 Women/kids 8 1 2 3 4 5    10 1 2 3 4 5   12 1 2 3 4 5    14 1 2 3 4 5 $ POLO SHIRTS: @ $45 EACH (white and magenta) (indicate number as appropriate) S 1 2 3 4 5    M 1 2 3 4 5    L 1 2 3 4 5    XL 1 2 3 4 5    XXL 1 2 3 4 5 Women/kids 8 1 2 3 4 5    10 1 2 3 4 5   12 1 2 3 4 5    14 1 2 3 4 5 $ NOTE: Clothing ordered after Feb 26th may not be avilable on race day.   TOTAL  $ WAIVER OR RELEASE: (you will be sent a confirmation of entry in February, which will include a participant declaration, which ALL riders will be required to sign and bring with them in order to complete registration. A copy is available. - view here. Acknowledgement of your entry will be posted on the website. MEDICAL CONDITIONS Please advise below of any medical conditions of which we should be aware. PRIVACY ACT: If you don't wish to receive information from our sponsors then put a check in the box. Payment options Cheque. Print this form and send with cheque payable to: Community Adventures Ltd , PO Box 15 1031, New Lynn, AUCKLAND Credit Card. When you click submit you will be redirected to a secure ASB bank page to enter your credit card details - please have your Visa or Mastercard ready. Enquiries: Jim Davidson, PO Box 15 1031, New Lynn, Auckland.                  Ph: 021 648 085.  Email: jim@colvilleconnection.co.nz Please print the form off and send to the address above.