【Entry Form】 THE 36th TOUR DE OKINAWA
Nov.9(Sat) - 10(Sun) 2024

Application Period: From 12:00 on Thursday, August 1 through 17:00 on Friday, September 20.
※However, applications will close once the capacity is reached.

Category Number

Total Entry Fee

Category Name

Participants for 2 Category Category Number

For Official Use

Yen*Please write the total amount if you are participating 2 races.
*The category numbers can be found on the left side of eachcategory name in the table below.

Category Name

If you are participating in two categories, please write the name of each category.

(Applicable only to participants of the Yanbaru Century Ride, Challenge Cycling, Ie Island Family Cycling, and Warumi Bridge & Kouri Bridge 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]*Participants in the Yanbaru Century Ride, Challenge Cycling Course, IE ISLAND Family Cycling and WarumiBridge & Kouri Bridge Cycling can combine with the Sunday event.

Category

1 Touring Around Okinawa Island Course

For the general public(high school students and above). 18,000yen 5
For the general public
8,000yen

2 Yanbaru Century Ride *163km
3

Entry Fee
For the general public(high school students and above). 38,000yen 4(high school students and above).

Warumi Bridge & Kouri Bridge Cycling Middle school students

Elementary school students(3rd grade and above)

Entry Fee
For the general public(high school students and above). 10,000yen

Category

Challenge Cycling Course *70km
IHEYA ISLAND Cycling

6,000yen 6 IE ISLAND Family Cycling *50km
5,000yen

Middle school students

22,000yen

Elementary school students(3rd grade and above)

18,000yen

Middle school students

10,000yen

Elementary school students

8,000yen(3rd grade and above)■ 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.

Remarks

Category

non-JCF Members H. School. Stu.

7 International Women's Road Race *100km

20,000yen 10,000yen

０００yen16 Citizen Road Race *50km Over60 (60s-over) １5，8 Citizen Road Race *200km

37,０００yen

17 Challenge Race *200km

30，０００yen

9 Citizen Road Race *140km Open32,000yen 10,000yen

18 Challenge Race *50km Open13,000yen

10 Citizen Road Race *140km Masters

13,000yen

32,000yen

19 Challenge Race *50km Forty(40s)

11 Citizen Road Race *100km Open27,000yen 10,000yen

20 Challenge Race *50km Over50 (50s-over) 13,000yen

12 Citizen Road Race *100km Masters

27,000yen

13 Citizen Road Race *50km Open

21 Women’s Citizen Road Race *50km

１5，０００yen 10,000yen

14 Citizen Road Race *50km Forty(40s)

22 Male Junior H.School Students’ Road Race 50km

6,000yen

１5，０００yen

15 Citizen Road Race *50km Fifty(50s)

１5，０００yen

23 Kids Race 10km

4,000yenName(Please print clearly)*This information will be indicated in thecompletion certificate. Please fill out correctly.

SexBlood Type

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

〒Address

E-mailtype(15 y/o or yaunger

DiscCompany Name:

Name of Cycling Club You Belong To:

Rim

Date of Birth
Date

Age on Event DayYearYears Old

Home Phone Number（）−（）−（）

Cell-Phone Number （）−（）−（）

JCF license numbers(Example:99MC999999)

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

Emergency Contact Name:Contact

4th-6th Graders Race for bothMale and Femal Students)*Please ensure that your email address is correct as you will receive a notification of your participation by email.

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

8,000yen

１5，０００yen 10,000yen 6,000yen

MonthM・FRemarks

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 ○.
All omitted T-shirt sizes will be assumed to be size L.

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

sizeSMLXL

Length (cm)

66

70

74

78

Width (cm)

49

52

5559

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
Tour de Okinawa 2024
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 before
and 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 eventorganizer, 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 ofmy 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), 2024
Participant’s Signature:
Parent’s Signature:(Necessary if the entrant is 18 years old or younger.)[About the participation notice]
Participation notification information will be sent by email from Sports Entry approximately two weeks before the event and the day before theevent (tentative).
*Please set your e-mail settings so that you can receive e-mails from "info@sportsentry.ne.jp".
*Participation notification information will be sent using the electronic ticketing service. *If you do not have a smartphone, please print out the'Entry Confirmation Email' or 'Payment Confirmation Email' sent to you after payment and bring it with you on the day.

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM
Tour de Okinawa 2024
All the personal information you filled in will be used exclusively for the purpose of organizing Tour de Okinawa
bicycle event in the year 2024 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 050-1721-2648
Web: http://www.tour-de-okinawa.jp
Address: Hokubukaikan Bldg. 5-2-7 Umusanomori, Nago City, Okinawa, Japan 905-0009