Should you wish to book for the Action Gear Adventure - River Rafting, Please fill in the form below.
Please don't leave out any details as all information is important.
For more information, Please visit the
terms and conditions page
or contact Terence Vrugtman on 073-051-5611.
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Name:
Email:
Comment:
First Name
Last Name
Contact Number
Preferred Email Address
*
Sex
Female or Male
Age (as of 1st February 2015)
Rafting event open to those between the aged of 10yrs and 80yrs.
ID Number
Shirt Size
Medical Aid Provider and Plan
If none, type 'Private'
Medical Aid Number
If none, type 'Private'
Doctor Name and Surname
Doctor Contact Number
Emergency Contact Person
Emergency Number
Customer Groups
General
Wholesale
Retailer
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MAGE_CUSTOMER_GROUPS
General
Wholesale
Retailer