The Audax Club of Australia (Inc.) - A0014462N

RIDE ENTRY FORM – to be completed by all riders

1. I wish to enter the 200 km randonnee at Banyo to be held by The Audax Club of Australia on _28_/_07_/_2007 I understand the nature and method of conduct of the event.

2. I agree to abide by the Ride Rules of The Audax Club of Australia.

3. I agree to comply with the traffic and road laws and regulations of the State/Territory in which I am travelling as they affect the use of a bicycle.

4. I fully understand and agree that I am entering this event entirely at my own risk and accept without exception full and complete liability for all and any risks and will not hold responsible nor make claim against The Audax Club of Australia, its committee members, agents or servants for any loss, damage or injury however caused in relation to my participation in this event.

5. I understand that I am required to comply with the lighting requirements set out in the Ride Rules. These requirements apply for a ride on which any part of the maximum time is at night (ie, between sunset and sunrise), and include:

- having an efficient front and rear light and a rear red reflector attached to the bicycle (and spare front and rear lights)

- having those lights switched on at all times of darkness or low visibility

- wearing a reflective vest or bandolier at all times of darkness or low visibility.

SIGNATURE______________________________ DATE / /

NAME ___________________________________ MEMBERSHIP NO._______________

ADDRESS _______________________________________________________

__________________________________ POSTCODE___________

PHONE (h) _________________ (w)___________________(mob)_________________

EMERGENCY CONTACT: NAME & NUMBER ________________________________

APPLICATION FOR TEMPORARY MEMBERSHIP – to be completed only by riders who are not members of The Audax Club of Australia or Cycling Australia

I wish to apply for temporary membership of Audax Australia. I understand that this membership applies for the duration of this ride.

SIGNATURE_________________________

Ride entry fee (200) $ 15 $ _______

Temporary membership fee $ 5 $ _______

Medallion (200 – 1000 km) $ 8 $ _______

Cloth badge (50 – 200 km) $ 5 $ _______

Late entry fee $ 5 $ _______

TOTAL COST $ _______

PARENTAL CONSENT – for riders of less than 18 years of age

I have read and understood the information contained on this entry form. As the parent/guardian of ___________ (name), I consent to my child taking part in this ride organised by The Audax Club of Australia

Name: ________________________ Signature: __________________