Jeremy Dickson

Corporate Challenge Team

Team: Allan Gray 2

Laps Entered: 3

Money Raised: R 3500

Sponsor Jeremy Dickson

Please fill in all fields carefully. The reason that we need your mobile number is in case you move jobs before the event takes place and your email address changes. We will not sell or pass on ANY of your personal information. The participant and yourself will receive an email to confirm your sponsorship after submission.

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Unique ID

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Runner Email

Unique ID

Your Full Name:*

Title First Name Surname

Your Email:*

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Your Phone Number:*

Tax Certificate:*

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Address:*

Please fill in the address that must appear on your tax certificate.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Donor Type:

Natural Person

Company, Trust etc

Donor Identification:

ID / Passport

Donor Identification:

Company / Trust registration number

Country of issue of Donor Identification:

Tax Reference Number of Donor: (optional)

Trading Name of Entity if different from above:

Sponsorship Details – Challenge your chosen participant

You can sponsor a participant for more summits that they are attempting. This means that you will be setting them a challenge to do more than they intended. If they do the extra summit, they will raise more money for the charity, plus you get to make them suffer! OK, so you got it? 1 Summit at R 100 = R100 , 3 summits at R500 = R1500.00. etc.

Payment type*

When would you like to pay? If you choose to Pay Now you will be taken to the Payfast portal for immediate payment via credit, card, EFT, Snapscan or Zapper.

Pay Now

Pay Later

Sponsor type*

Select if you'd like to sponsor this participant per lap or lump sum.

Per Lap

Lump Sum

How many laps do you challenge your chosen participant to?*

How much money (in ZAR) would you like to sponsor per completed lap?*

Please enter a number greater than or equal to 100.

Total Amount to Sponsor*

Please add the total amount you'd like to sponsor.

Please enter a number greater than or equal to 100.

Total Amount Sponsored (per lap):

Price: R0.00

Total Amount Sponsored (lump sum):

Price: R0.00

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EVENT WEEK: 6 – 14 MAY 2023