Desert Challenge Logo

Simpson Desert Bike Challenge - Entry Form - 2010

Entries Close August 31, 2010 OR when the limit of 40 riders is reached

Competitors must be at least 18 years of age on the Race Start Date

Race organisers reserve the right to accept/reject entries at their discretion

Event Options

 
Individual
$ 600
After June 30th the entry fee is $650
Includes 1 Support Vehicle per rider
Extra Vehicle
$ 110
If you plan to bring 2 support vehicles tick this box
Help with Support
 
If you require help with arranging a support crew tick this box

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 Size:
How Found Out:
How did you find out about this event?

*At least one phone number must be included

Medical Questionnaire

All medical information is kept confidential and is only available to our Medical Team

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.

I Accept the terms and conditions as specified in the above 'Waiver and Release'

Entrant Accept

Payment

There are two options for payment.

  1. You can pay by Credit Card using PayPal
  2. You can pay by Direct Bank Payment using your Internet Banking (our preferred option)

Our Bank Details are:

  • Bank: Bendigo Bank
  • Acct Name: Desert Challenge Inc
  • BSB: 633-000
  • Account No: 130413412

Calculated Amount: $