Indemnity Please enable JavaScript in your browser to complete this form.Date / Time *DateTimeNAME OF EVENT *Name *FirstLastPhoneEMERGENCY PHONE *Email *ETHNICITY *WHITEBLACKINDIANCOLOUREDGENDER *MALEFEMALEBOTHPROVINCE/REGION (RESIDING) *CLUB MEMBERSHIP(WHICH CLUB?) *ANY MEDICAL CONDITIONS *SIGNATURE OF COMPETITOR *Clear SignatureAGREEI give permission to the club secretary to access my profile or create a new licence profile for me on the MSA online licence system. I furthermore grant him/her permission to electronically sign the MSA indemnity, medical declaration and POPI consent document on my behalf, and accept that I will be bound by such electronic signatures as if I had done them myself.Submit
