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Please do a seperate registration for each different delivery address.

Cost Of Bed ( x1 ) : R 5195

REGISTER AND PAY FOR YOUR ENTRY BEFORE 30TH JUNE 2017 AND PAY ONLY R4700

ADDITIONAL DISCOUNTS FOR MULTIPLE TEAM ENTRIES

 
Quantity of beds * :
Organization or Company Name * :
Your Name * :
Department * :
Company Physical Address * :
   
   
Email * :
Work Phone :
Cell Phone * :
Fax :
Your Team Name(s)* :
If you would like to challenge another company, provide details here: :
Additional info/Payment Terms :
(5 T-Shirts per team entered)    

 Small T-shirts:

:

Medium T-Shirts: :
Large T-Shirts: :
X-Large T-Shirts: :
When would you like your bed delivered? :
Please note: Bed will only be delivered on confirmation of payment in full*.
 
** Please enter the number on the Midrand Logo above: :

 

 

 

*Easy monthly payment terms are available

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