Return to the Mountain Bike Worldwide hub Application Form This is an application to enter Mountain Bike Worldwide events. 1 Event Selection2 Personal Details3 Race Experience4 Medical History5 Race Extras6 Terms & Conditions Are you a...*RiderCompanionLet us know if you'll be riding or just tagging along.Event*Please select the event you wish to enter - making sure to select the correct year.2017 - Yak Attack (November 3rd to November 16th, 2017)2018 - Pokhara IV (February 11th to February 16th, 2018)2018 - Yak Attack (November 3rd to November 12th, 2018)2018 - Rumble In The Jungle (June 8th to 15th, 2018)Quantity*Please enter a value between 1 and 1. Save and Continue Later Name* First Last Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Enter Email Confirm Email Phone*Sex*MaleFemaleNationality*Date of Birth* Age on first day of event*Passport Number* Save and Continue Later Have you ever travelled to Nepal before?*YesNoHave you ever travelled to Sri Lanka before?*YesNoPlease list your previous race / riding experience relevant to this eventOther relevant Mountain Bike experience Save and Continue Later Medical HistoryPlease indicate if you suffer from, or have ever suffered from, any of these medical conditions.Heart Trouble / Blood Pressure ProblemsYesNoAsthma / Bronchitis / Shortness of BreathYesNoDiabetesYesNoEpilepsy / Fainting Attacks / SeizuresYesNoMigraine / Severe Head InjuryYesNoCancerYesNoSpine / Back problemsYesNoAllergiesYesNoFractures / Dislocations / Tendon, Muscle, Ligament DamageYesNoInfectious Disease / Carrier for Infectious DiseaseYesNoPsychiatric / Mental IllnessYesNoHave You Been Hospitalized in the Last 2 YearsYesNoAltitude Sickness / A.M.S / Altitude Related ProblemsYesNoOther Physical Disabilities / Serious IllnessYesNoFurther DetailsPlease provide us with any details that may help us cater to the medical concerns mentioned above, or in addition.Specific Dietary RequirementsVegtarian, vegan etc. Save and Continue Later Extra ServicesPlease select any extra services you would like for the race.Event Add-onsAdd-ons for the Yak Attack 2017 package Massages - 8 x 30 minute sessions Bike Maintenance - 10 x clean and lubricate Yak Attack Jersey Event Add-onsAdd-ons for the Yak Attack 2018 package Massages - 4 x 30 minute sessions Bike Maintenance - 6 x clean and lubricate Yak Attack Jersey Event Add-onsAdd-ons for the Pokhara IV 2018 package Massages - 4 x 30 minute sessions Bike Maintenance - 4 x clean and lubricate Pokhara IV Jersey Event Add-onsAdd-ons for the Rumble In The Jungle 2018 package Massages - 4 x 30 minute sessions Bike Maintenance - 5 x clean and lubricate Rumble In The Jungle Jersey Taxi Transfer (Airport to Negombo) Taxi Transfer (Negombo to Airport) Jersey Size*Extra SmallSmallMediumLargeExtra LargeJersey Fit*MaleFemaleNumber of Airport to Negombo Passengers*Number of Negombo to Airport Passengers* Save and Continue Later Release of Liability * I have read, understand and accept the Release of Liability document. Race Rules & Regulations (Yak Attack)* I have read, understand and accept the Race Rules & Regulation document. Race Rules & Regulations (Pokhara IV)* I have read, understand and accept the Race Rules & Regulation document. Race Rules & Regulations (Rumble In The Jungle)* I have read, understand and accept the Race Rules & Regulation document. Terms & Conditions* I have read, understand and accept the Terms & Conditions document. Payment InformationTotal CostThe total cost for your entry is below. This is based on the cost of entry plus any add-ons you have selected. We'll vet your application for suitability and send you an acceptance letter. We then ask for payment of a deposit to secure the place, and the final balance 2 months before the event. $0.00 Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.