To send us your registration follow these simple steps:
1 Copy this entire page to your clipboard (Ctrl-A followed by Ctrl-C)
2. Click on the email line immediately below step 6 to open an email addressed to us
3. Paste to copied page into the email (Ctrl-V)
4. Fill in the table with your details directly into the open email
5. Press the send button
6. You will still need to print and sign the declaration portion of the form below and bring it with you to the event
Email: admin@laurelhillforestlodge.com.au
Alternatively, you are welcome to print this page then post or fax to the address below.
Friday 2nd April to Monday 5th April 2010
$290.00 per person
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Your name |
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| Partners name | |||||
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Gender (Please Circle) |
Male Female |
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Phone (home) |
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Phone (work) |
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| I will be riding a | Road Bike | Mountain Bike | |||
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I am a Non Rider |
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Emergency Contact Name |
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Emergency Contact Number |
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Special Dietary requirements |
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Other (eg Medical info) |
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PAYMENT OPTIONS:
□ $100.00 DEPOSIT sent with registration form email, fax or post with balance paid by 8th March 2010
□ Pay in full $290.00 per person
PAYMENT METHODS:
□ By cheque made out to ‘Laurel Hill Forest Lodge’ Post to 1670 Batlow Road Tumbarumba 2653
□ By direct deposit Westpac Bank Details: Laurel Hill Forest Lodge BSB 032 766 Account No.112395
I understand that bicycle riding carries some degree of risk and I hereby accept all responsibility for my actions. I have enough ability and experience to participate safely in this event. If under 18 must be signed by a parent.
Signature Date
Signature Date
Signature Date
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| Email:admin@laurelhillforestlodge.com.au |
| Phone:02 6948 8669 Fax: 02 69488665 |