【Entry Form】 THE 35th TOUR DE OKINAWA
Nov.11(Sat) - 12(Sun) 2023

Application period starts from Tue. August 1, at 12:00 through Sat. September 30, 17:00.
＊However, it closes immediately after reaching a capacity.

Category Number

For Official Use

Total Entry Fee

Category Name

Participants for 2 Category Category Number

Yen*Please write the total amount if you are participating 2 races.
Category Numbers can be found on the reverse side of this page

Category Name

The person participated in to the second category, please fill in the name of each races. (Subject matter only for Yanbaru
Century Ride, Challenge Cycling, and Ie Island Family Cycling.)
Not available to the categories start on same day.
※Those for whom it applies to 200 km of citizen races need to fill in the participation track record in a road race convention (latest).
Name of the road race convention, race category () Time ()■ START on Saturday [Possible to apply for 2 events] *Possible to combine with events on Sunday.
Category

Entry Fee

Category

Elementary School Students

Elementary School Students

Entry Fee

1 Yanbaru Century Ride *173km

14,000 yen−3 Ie Island Family Cycling *50km

10,000 yen

8,000 yen

2 Challenge Cycling Course *90km

11,000 yen−

4 Izena Island Cycling Course *60km

20,000 yen

18,000 yen■ START on Sunday *Applications for events that are scheduled to start on the same day can not be allowed to duplicate.
[Race Section]
Category

non-JCF Members H. School. Stu.

5 International Women's Road Race *100km

20,000 yen

6 Citizen Road Race for Men *200km

35,000 yen

7 Citizen Road Race for Men *140km Open30,000 yen

8 Citizen Road Race for Men *140km Masters

30,000 yen

9 Citizen Road Race for Men *100km Open25,000 yen

10 Citizen Road Race for Men *100km Masters

25,000 yen

11 Citizen Road Race for Men *50km Open15,000 yen

12 Citizen Road Race for Men(40s) *50km

15,000 yen

Name(Please print clearly)

CategoryRemarks

10,000 yen

10,000 yen

non-JCF Members H. School. Stu.

13 Citizen Road Race for Men(50s) *50km

15,000 yen

14 Citizen Road Race for Men(60s-over) *50km

15,000 yen

15 Challenge Road Race for Men *50km Open13,000 yen

16 Challenge Road Race for Men(40s) *50km

13,000 yen

8,000 yen

17 Challenge Road Race for Men(50s-over) *50km 13,000 yen

10,000 yen

10,000 yen*This information will be indicated in thecompletion certificate. Please fill out correctly.

18 Citizen Road Race for Women *50km

15,000 yen

19 Male J.H.School Students' Road Race *50km

6,000 yen

20 Road Race for Kids *10km

4,000 yenSex

Blood Type

M・F
*Please fill in the address which can receive a number
exchange certificate etc.

Addresstype(15 y/o or yaunger
6,000yen

10,000 yen

4th-6th Graders Race for bothMale and Femal Students

Date of BirthMonth〒Remarks

Age on Event Day

DateYear)Years OldHome Phone Number（）−（）−（）

Cell-Phone Number （）−（）−（）

JCF license numbers

E-mail(Example:99MC999999)

Race applicants, please circle
it in which brakes to be used.

DiscCompany Name:

Name of Cycling Club You Belong To:

Rim

Race applicants, please circle it inwhich sprocket gear to be used.

Emergency Contact Name:
Contact

10-speed

This information will beused for during result
presentation. Please fillout correctly.

11-speed

12-speedYour Personal Race/Cycling History:
Years

Contact Phone Number:（）−（）−（）

Past illnesses, Allergies, Medications *This information will be necessary for emergency medical care during the event. (T-shirt)Please mark an appropriate box with ○.

Remarks: Self PR / Requesting a shared room on Izena Island, etc.

sizeSMLXL

Length (cm)

66

70

74

78

Width (cm)

49

52

5559

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
Tour de Okinawa 2023
1. I acknowledge that the general rules, regulations and particulars have been set by Tour de Okinawa
Organizing Committee for the safety of all participants and I hereby agree to abide by all the rules andregulations as set forth by the event organizer.
2. I pledge to take necessary precautions against risks, injuries and other causes hazardous to my health beforeand during the race; if there is any health problem arises before and during the event, I will refrain from theparticipation of or retire from the race/cycling.
3. I acknowledge that cycling has an inherent risk and I fully agree to assume the risk associated withparticipation of this event. Therefore, I agree it is my sole responsibility to follow the regulations and to takesafety precautions in order to safely participate to this event. I agree to release the liability of the event
holder/organizer or of any member of the organization or of personnel related with event for any injury,
permanent damage or death as a sequel to an incident/accident during the event. However except where
there is a gross negligence in the event organizer. Exception of where there is a gross negligence in the event
organizer, I understand that the event organizer take out accident insurance for all participant but the rangeof insurance is limited; I agree to seek medical services within the range of insurance and if there is a needfor further medical service, I pledge to use an injury insurance which I take out on my own. I also certify
than any of my family or relatives, friends or business colleagues will not seek compensations for the loss of
my personal properties or for my injury, permanent damage or death beyond the limitations of the insurance.
4. I understand this is my sole responsibility to take care of my personal item(s) and even if it(they) is lost, stolen
or damaged in any way, I pledge not to seek any compensation for it(them) from the event organizer.
5. I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident
and/or illness during the event.
6. I hereby agree to waiver my rights to seek refund of entry fee, compensation or liability for the loss or damageof my personal item(s) on the event organizer which, in an event of weather deterioration or
natural/environmental disaster or any other conditions beyond the control of the organizer, changes theschedule or content of the event.
7. I consent that my name, photos and videos, etc., will be used by various media agencies for commercial
secondary use such as broadcasting and DVD production related to the Tour De Okinawa. As well as thewebsite / publications and printed materials (including for sales purpose) created by the tournament
organizer or authorized organization, I agree to freely use them.
*The organizer holds the right of publishing information and the right of publicity concerning the race such asvideos, photographs, records, location information, entrants' names, via TV, newspapers, magazines, theinternet, etc.
8. I have read and understand the terms and conditions written in this form and I hereby certify that the dateand sign are truly of my own.
(month)(date), 2023
Participant’s Signature:
Parent’s Signature:(Necessary if the entrant is 18 years old or younger.)

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
Tour de Okinawa 2023
All the personal information you filled in will be used exclusively for the purpose of organizing Tour de Okinawa
bicycle event in the year 2023 and for sending the direct mail with the entry form attached for the following
years’ events to your home address.
For further inquiry regarding application: Call 0980-54-3174
Web: http://www.tour-de-okinawa.jp
Address: Hokubukaikan Bldg. 5-2-7 Umusanomori, Nago City, Okinawa, Japan 905-0009