tel (011) 979-0002.

082-870-6134
www.familyadventures.co.za

QUADS 4 QUADS 2009

Booking Form: JHB to Durban in the Dirt
QASA NPO 000881

An Adventure of a lifetime for a great cause.

Dirtbikes, Big Trailies, Side by Sides and Quads are all Welcome….
Space is Limited – If you want to come get your bookings in early.
$o Team Bookings: 1 booking form per person please…
Raising funds for the QuadPara Association of South Africa (QASA)
“developing the full potential of quadriplegics & paraplegics”
www.qasa.co.za
Four Days Of Riding Through Three Provinces:R2600.00 pp.
A percentage of your fee goes directly to QASA
Backups, drivers and crew R1600pp
Price includes all meals and camping
Resolution Health and insurance medical backup.
MA$ trucks are supplying a huge backup truck or two.
Mobile workshop by Loxtons Suzuki
A commemorative tee shirt.
A ride of some note and a life changing experience for a great cause
Due to requests in the past, we are having limited edition Riding Shirts made.
The cost is R400.00 per shirt. Please see the booking form.

Suitable for all rider skill levels with some lekker technical stuff in between.

Approx 250 kays of riding per day.

Fuel stops all the way – about 100 kays between each stop
Kick off from Jhb on Thursday Morning: 24th September 2009.
Arrive Ballito: Sunday 27th September.

This is a real family off road adventure – you ride your motorcycle, side x side or quad the whole way (950
kilometers).
We will take you to places that most people who live here will never get to see.
The ride changes everyday, and we have a few new sections that previous participants have not ridden
before. From the rolling hills of KZN, to thick indigenous forests to rocky mountain passes and beautiful
farmlands, you will see it all.
 Here is how you book:

$o Team Bookings: 1 booking form per person please…

$o verbal bookings will be accepted: Here is what you need to do:
1) Fill in your booking form: Please use a black pen, write neatly and fill in every question. One form per
person whether you ride or if you are doing backup.

2) There is a credit card option, please contact Anette at (011) 979-0002 for details.

Please only use the Quads 4 Quads banking details.

- Ref on Deposit slip - name and surname - Q4Q.

- If you are paying for more than 1 person please write their names on the deposit slip before sending it
through.
- If your company is sponsoring you and you cannot get the deposit slip, please supply us with: The date
of payment, the ref. used, the amount paid in and a list of the participants on a separate page with your
booking form.

3) Fill in the medical forms neatly in black pen.

4) Send your completed booking form, Medical form and deposit slip to:
familyadventures@mweb.co.za

Or you can fax to these numbers:

(011) 979-0002. (011) 979-1363. 086-541-1390

Please note that your booking will only be processed upon receipt of all of
the following:
Booking Form, Medical Forms and Deposit slip.

When we receive these three documents, we will send confirmation of your

booking.

A second, more detailed info sheet of times and places will be sent out closer
to the event date.
PLEASE WRITE $EATLY

You need to attend the pre ride briefing and registration on the evening
prior to the ride kicking off.

If you have any questions, please drop us a mail at foleyg@mweb.co.za

If you want to read the story of a quadriplegic’s experience riding in this awesome event then email
info@qasa.co.za

If you would like information about QASA sent to you please email: info@qasa.co.za
 BOOKING FORM page 3
1 Form per person…
Riders R2600pp. Backup R1600.00pp

Please fill this out – 1 form per rider. 1 form per backup person.
Fax/email it along with your deposit slip and medical form to:
(011) 979-0002. (011) 9791363. 086-541-1390
OR email to familyadventures@mweb.co.za

Please write neatly:

First name:…………………………Surname:……………………………………………

Are you a Rider or a Backup? (write) ……………......(Backup is the person driving your groups bakkie)

Rider who is your backup?……………………………Backup Tel $o……………………………………

Backup who are your riders?………………………………………………………………………………..

Tee Shirt Size (included in your entry fee)…………………………(s, m, l, xl, xxl, xxxl,)

Would you like a commemorative Riding Shirt (R400.00)?........................... Size………………………..

Queries?.................................................................................................…………………................................

Your Cell phone $umber:………………………………………………………………...

Your Landline Phone $umber……………………...Fax ………………………………

Your Email Address (print neatly)………………………………………………………

A 50% DEPOSIT IS $EEDED TO SECURE YOUR BOOKI$G.

THE BALA$CE IS DUE $O LATER THA$ FRIDAY THE 28th AUGUST
$o Verbal Bookings!!!!

This is the only account to be used

Bank Details:
Account name: Family Adventures Quads 4 Quads
Standard Bank Benoni
Current account: 01 249 9447
Branch code 013042

USE YOUR $AME A$D Q4Q AS REFERE$CE

When we receive the booking form, medical form and deposit slip, we will send you confirmation and more detailed
information. Cancellations will be accepted up to the 28th August. After that your deposit goes to QASA.

Phone (011) 979-0002. (011) 979-1363

Email: foleyg@mweb.co.za
 Page 4: Medical Forms: Resolution Health And Insurance
Please complete this form and fax it to:
(011) 979-0002. (011) 979-1363. 086-541-1390

P.S: This form is compulsory, and no rider will be allowed to participate in

the event without filling it out.
Please write neatly – get your better half to fill it out if your writing is anything like ours.
One form to be filled in per rider. One per backup.

Name: __________________________Date of Birth:_____________________________

ID Number: _____________________ Sex: ___________________

Your Current Personal Medical Information:

Blood Group________________
Your Medical Scheme (Medical Insurance): Company:__________________________
Membership No: _________________________
Allergies to Drugs/Medications:
None
Antibiotics (specify): ___________________________________________
Narcotics (specify): _______________________
Aspirin Medical/X-Ray Dye___________________
Other Allergies (please specify)
______________________________________________________________________________________
__________________________________________________________

Persons to Contact in an Emergency:

Name 1:____________________________________________
Relationship: __________________________
Phone (Daytime):_____________________Phone (Evening):_____________________
Name 2:____________________________________________
Relationship: ___________________________
Phone (Daytime):________________________Phone (Evening):________________
Physician/GP:
Personal Physician: __________________________________
City/Province: ___________________________
Phone (Daytime):____________________ Phone (Evening):______________________
Specialist: ________________________________________
City/Province: ____________________________
Phone (Daytime):__________________Phone(Evening):________________________

Medications (Prescription or over-the-counter):

None
Antibiotics (specify): ………………………………………………………………………
Aspirin
Narcotics (specify)………………………………………………………………………….
Digitalis/Digoxin Insulin
Nitroglycerin (TNT)
Steroids Lasix Phenobarbital
Other ( Please Specify)……………………………………………………………………..
Previous Medical History – please tick:
No Past Medical Problems
Diabetes Immune System Disorder Abnormal Electrocardiogram.
Emphysema, Asthma or Lung Disease Seizure or Epilepsy Heart Attack or Angina Stroke or Brain
Hemorrhage.
Bleeding Disorder Hepatitis
Other:
______________________________________________________________________________________
__________________________________________________________

Previous Surgery/Procedures: Please tick

None
Appendectomy
Gallbladder Removal
Joint Replacement
Angioplasty
Cardiac Bypass
Hysterectomy
Valve Replacement
Other (please specify):
______________________________________________________________________________________
__________________________________________________________

Medical Devices:
None Contact Lenses Hearing Aid Joint Replacement
Artificial Heart Valve Dialysis Shunt IV Line/Shunt Pacemaker
Automatic Internal Defibrillator Gastrostomy Tube
Other (please specify)
_______________________________________________________________________
Personal Information Attached:
None
Copy of ECG Other Medical Image (specify) ___________________________________
________________________________________________________________________

Additional Medical Information (please specify):

________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
____________________________________________

Family Adventures: foleyg@mweb.co.za

(011) 979-0002. (011) 979-1363
Cell $umbers: 072-177-0621 082-870-6134 083-314-2203
Fax $umber: (011) 979-0002. (011) 979-1363. 086-541-1390
www.familyadventures.co.za
Please note: There was confusion last year – the event starts on the morning
of Thursday the 24th. The briefing will be in JHB at Grasslands driving
range on the evening of the 23rd.
If you are coming up to JHB, you need to arrange accommodation on the
Weds evening in JHB.
On Sunday, the event ends at Cane Cutters. If you are staying on, you need
to arrange for the sleepover.

If you need accommodation in JHB for the evening before the ride or the night that you arrive back:

Camping: You can camp at the start, there are clean ablutions and so-on. contact Ryan:

Willow Park: (011) 565-6600 near OR Tambo Airport.

10 minutes from the riders briefing. 20 minutes from the start of the ride.

Kopanong Hotel: (011) 749-0000 next to the briefing venue, 20 mins from the start of the ride.

Lux Accommodation at the start: Medley house (011) 740-1272

You will need to trailer your bikes to the start on Thursday morning.

If you do not want to camp, these are the numbers to call for
accommodation en route:
Standerton (Thursday the 24th) Hostel: (017) 712-2345

$ewcastle (25th Sept) Majuba Lodge (034) 315-5011

Weenen (26th Sept) Owl and Elephant (036) 354-1147

Ballito (27th Sept) Cane Cutters (032) 947-0851

This is a family ride and a brilliant adventure for dirtbikes, side by sides, quads and
big trailies. Alchohol is banned on the trail – QASA does not need new members.

That’s it. If you have any queries, please feel free to drop us a mail or give us a call.

Come along, have fun and enjoy the adventure of a lifetime.

www.familyadventures.co.za