Simpson Desert Bike Challenge

Simpson Desert Bike Challenge - Entry Form - 2008

Entries Close August 31, 2008
Competitors must be at least 16 years of age on the Race Start Date
Competitors 16 or 17 years of age must be accompanied by a parent or guardian
Race organisers reserve the right to accept/reject entries at their discretion

Event Options

	Individual	$	580	Includes 1 Support Vehicle per rider
	Extra Vehicle	$	110	if you plan to bring 2 support vehicles tick this option
	Help with Support?			if you require help with arranging a support crew tick this option

Personal Details

First Name:
Surname:
Date Of Birth:	Day Month Year 4 digits e.g. 1975

Gender:

Male

Female

Address:		City:
		State:
		Postcode:
		Country:

*Home Phone:

Mobile Phone:

Work Phone:

Email:

Tshirt:

*At least one phone number must be included

Medical Questionnaire

Q1. Do you take any regular medications? Yes

Details:

Q2. Do you have any allergies or sensitivities to medications, insect stings, foodstuffs etc ? Yes

Details:

Q3. Have you been treated by a physician for any significant medical condition/problem, excluding routine matters such as colds, flu, etc. in the past twelve months. Yes

Details:

Q4. Do you have any current medical problems or conditions for which you are being treated by a doctor? Yes

Details:

Q5. Have you ever received Medical Treatment for Hypothermia (low body temperature)? Yes

Q6. Have you ever received Medical Treatment for Hyperthermia (heat stress)? Yes

Q7. Have you ever required medical treatment during or following an endurance event? Yes

Details:

Q8. Do you wish the medical staff of the SDBC race to be aware of any specific medical issue? Yes

Details:

Waiver and Release

I AGREE to comply with the rules, regulations, and event instructions of the SIMPSON DESERT BIKE CHALLENGE
I UNDERSTAND that participating in a mountain bike race is a potentially hazardous activity and can result in serious injury or death. I am aware of and I expressly assume all inherent risks associated with participating in this event, including, but not limited to, falls, contact with other participants and objects, the effects of weather, including high heat and humidity, traffic, and the conditions of the road.
IN CONSIDERATION of your accepting this entry, I for myself and anyone entitled to act on my behalf, waive and release from any and all claims for injuries and damages I may have against the Desert Challenge Committee, medical and paramedical practitioners, all groups and individuals associated with the conduct of the event, the sponsors, their agents and representatives, caused by the negligence of any of them arising out of my participation in this event, including pre and post race activities.
I ATTEST that I am physically fit and have sufficiently trained for completion of the SIMPSON DESERT BIKE CHALLENGE
I CONSENT to receive medical treatment which may be advisable in the event of illness or injuries suffered by me during this event, and I agree to pay for the costs of my medical treatment, if required.
I GIVE PERMISSION for the free use of my name, voice or picture in any broadcast, telecast, advertising promotion or other account of this event.
I AGREE that electronic submission of this application constitutes agreement to all the terms of this waiver and release.

Entrant Accept	I Accept
Guardian Approval	(required for entrants who are under 18 on the first day of the event)
Guardian Name
	I certify that I am the parent/guardian of the said entrant and that he/she has my consent to participate in the Simpson Desert Bike Challenge
Guardian Accept	I Accept

Payment

Go to Secure Payment System

Calculated Amount