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Corporate Cycling Challenge

 
    The Corporate Cycle Challenge Entry Form

Company Name:
Address:
Suburb:
Postcode:
Contact Person:
Work Phone:
Mobile:
Email:
Secondary Contact Name:
Secondary Contact Email:
 
Team Name:

How did you find out about the event?

Please Select your Team Distance




Team Fees are $285.00 inc GST.       Individual Fees are $60.00 inc GST.


Team Members

team entry  individual entry

  Firstname Surname Gender Email Laps 

 1  M  F
    Time of Participation:  Book a Bike (optional): 

 2  M  F
    Time of Participation:  Book a Bike (optional): 



 3  M  F
    Time of Participation:  Book a Bike (optional): 



 4  M  F
    Time of Participation:  Book a Bike (optional): 



 5  M  F
    Time of Participation:  Book a Bike (optional): 



 6  M  F
    Time of Participation:  Book a Bike (optional): 



Participation Agreement

  1. All entrants acknowledge that they enter in the Corporate Cycle Challenge at their own risk.
  2. I confirm the main contact making this booking that I am 18 years and over.
  3. In consideration of and as a condition of acceptance of our entry in the Corporate Cycle Challenge for ourselves, our respective heirs, executors and administrators, we and each of us severally hereby waive all and any claim, right or, causes of action and forever release and discharge all persons, corporations and bodies involved or otherwise engaged in promoting or staging the event and the servants, agents and representatives and officers or all or any of them which we or more of us our respective, heirs, executors and administrators might otherwise have for or arising out of: i) loss of life or injury, damage or loss of any description whatsoever and howsoever caused suffered or sustained in the course of, consequence upon or incidental to our entry or participation in the said event, and (ii) any publication, or use in any form of media whatsoever, of our or any one or more of our names, photographs, or activities in, or incidental to our entry or participation in the said event and whether for advertising or otherwise.
  4. The above release and discharge shall be and operate separately in favour of all person, corporations and bodies involved or otherwise engaged in promoting or staging the said event and the servants, agents, representatives, and officers of all and any of them and includes but is not limited to ENVENTIVE, LLEM Inc, Life. Be in it, Adelaide City Council and any other sponsors.
  5. Privacy Information:
      1. This information is collected by Enventive, ‘Life. Be in it’ SA Inc,
      2. This information will be stored on a database. You are able to obtain access to this information by contacting Enventive Inc.

I hereby acknowledge that I have read, understood and accept this agreement, and I have made this declaration available to all Competitors associated with this Logon.


Please check the above details very carefully before clicking on the submit button.

You can pay immediately via Stripe (credit card) by clicking the button on the left.
Click the button on the right to submit your details and receive a printable Invoice.