Entry Form: New Zealand MTB-Orienteering Championship 2004
Contact Name
	Phone	
Street Address

Email Address
	
NOTE: Final Details and Results will be sent by EMAIL unless you don’t have a computer and online access.	Do you need to hire a SPORTIdent e-card?    YES /NO
Are you a member of an orienteering club?    YES / NO	

First Name	Last Name	O’  Club	SPORT
IDENT	Birth Year	Class Day1	Class Day2	Entry Fee	

								
								
	Ordinary Total $		
Add $3 per person for SPORTIdent card if hire required:	E-card Hire 		
Add $9 per person per competition day if not a member of an Orienteering Club:	One Day Registration		
Cheques payable to “Counties Manukau OC”. Post to “MTBO Champs”, 9 Koromiko Pl, Waiuku 1852	TOTAL $