Easter Feast of Cycling 2017 Registration Form

Easter Feast of Cycling 2017 Registration Form

Friday 14th to Monday 17th April 2017 $430.00 per person

Registration forms can be posted or emailed to admin@laurelhillforestlodge.com.au

Your name: ________________________________________­­­­____    Male       Female

Partners name: _________________________________________     Male       Female

Address: ________________________________________________________________

Email address: ___________________________________________________________

Phone (home): _______________________Phone (work): _______________________Phone (mobile): __________________________________

Emergency Contact Name: ___________________________________________Emergency Contact Phone Number: __________________________

Special Dietary requirements: ____________________________________________________________________________________________

Other (eg Medical info): ________________________________________________________________________________________________

I / We will be bringing a: Roadie                  Mountain Bike                     Non Rider

PAYMENT OPTIONS:

$100.00 DEPOSIT per person on registration, with balance paid by 14th April 2017

Pay in full $430.00 per person on registration

Linen hire @ $22.00 per bed

PAYMENT METHODS:

By cheque made out to ‘Laurel Hill Forest Lodge’ Post to 1670 Batlow Road Tumbarumba 2653

By direct deposit Bendigo Bank Details: Laurel Hill Forest Lodge BSB 633 000 Account No.156987844  Please include your surname when making a direct deposit.

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 or guardian.

Signature _______________________________________ Date__________  Signature _______________________________________ Date __________

If you are emailing this form back, the form can be signed on the 14th April 2017 when you arrive at Laurel Hill Forest Lodge.