ENTRY FORM - CCIA BIKE RIDE

MAX. 200 Riders
Print, complete, and send entries to:- CCIA Bike Ride C/o 82-84 Mooney St, Gulliver 4812
Ph (07) 4725 2599
* Entry forms must accommodate entry fee * Deadline for entry forms - 26th June 2001
ENTRY FEE: $95.00/ PERSON * Plus each rider must raise $200 min.
Entry fee: includes insurance, riding shirt, admission tickets for function, meals, accommodation and return transport.
Shirt Size S - M - L - XL * If you require special sizes, please specify.

Name:___________________________________________________DOB:__________________________

Address:________________________________________________________________________________

Town:________________________State:_____________________P/Code:__________________________

Phone:(H)__________________(W)____________________(M)_____________________

Next of Kin:_______________________________________Phone:______________________

Address:________________________________________________________________________________

* I would like to volunteer

Name:__________________________________________________Phone:_________________

Participant's Agreement/Conditions:

I acknowledge that places on the CCIA Bike Ride are limited and that even if I submit this entry by the closing date, Tue 26th June 2001, it cannot be accepted if numbers are full.
I understand that the CCIA Bike Ride involves riding on roads used by others and may be hazardous.
In my judgement I/my child have/has sufficient competence and experience to participate in the CCIA Bike Ride.
I release those involved in the planning, organisation or implementation of the CCIA Bike Ride and the sponsors of the CCIA Bike Ride (The Organisers) from all claims and, indemnify the organisers against all expenses, loses, damages and costs that may resonably incur as a result of participation by me/my child in the CCIA Bike Ride, except to the extent to which those claims, expenses, loses, damages and costs are contributed to be negligence of any of the organisers.
Conduct which in the opinion of the organisers is or may be, or result in a threat to cyclists' safety, criminal activity, bad language, or other unsociable behaviour may result in exclusion from the CCIA Bike Ride without refund.
CCIA Bike Ride organisers can refuse entry without detailing reason and, can change the route without notice.
Cancellations - I acknowledge that if for any reason I/we cancel my/our entry, I will receive no refund.
I understand that I should not compete in this event unless I have trained appropriately and my physical condition has been verified by a medical practitioner.
All bicycles must undergo a roadworthy inspection by Better Bikes and Aquariums - Townsville, Pump'n'Pedals - Cairns.

Signature:__________________________(Participant/Parent/Guardian)

Name:_____________________________________________________________