We respect that information given is confidential and will not be shared in any way. * Required fields *First Name *Last Name *E-mail Postal Address NumberStreet Suburb State Post codeCountry *Telephone Home Work Mobile *Date of birthDay Month Year *Gender Male Female *Cycling Jersey size We would like to offer you 2 jerseys and a couple of casual shirts for your trip with us, please let us know your size. :::Choose Below::: Female XX Small Female X Small Female Small Female Medium Female Large Mens X Small Mens Small Mens Medium Mens Large Mens X Large Mens XX Large Mens XXX Large *Tour Northern Italy + Giro d Italia AUD$5000 *Friends Room to myself Twin share Your own room will ass an additional $50AUD per day If twin share, who do you want share with Are there others in your group, if so, can you list them please Medical form: Required for public liability insurance! *Next of kin Name Home Work Mobile *Conditions Do you suffer from any conditions Asthma Heart Diabetes Fits or dizzy spell Respiratory problems Blood pressure Allergies If yes to any reactions, is the reaction Local (affecting more than 50cm of the area) General (affecting different parts f the body) Specify any relevant conditions below: * Conditions of Entry includes; Assumption of Risk Waiver and acknowledgement 3. Cancellations & late fees Event & route variation Refusal of entry Care of your equipment Information Photography Protecting your privacy 1. I understand that participation in this Ride is subject to the Conditions of Entry and that it is an important document which affects my legal rights. I acknowledge that a copy of the Conditions of Entry document has been made available to me. 2. I will purchase travel and make sure my policy is valid before travel I ACCEPT I (the participant) have read, understand and accept the Conditions of entry We are unable to accept your entry without your acceptance of the conditions of entry Click here to read the conditions of entry Your payment details (Credit Card by secure transaction) *Payment Details Payment required to secure your position! Payment schedule: Deposit $500 AUD upon booking, Balance is required two months before the event. (Refund policy) Payment Method Choose Below::: Direct Deposit VisaMastercardBankcardCheque Credit Card Please charge deposit of $500 to my card. Card Number Expiry 1 2 3 4 5 6 7 8 9 10 11 12 2007 2008 2009 2010 2011 2012 2013 Direct Deposit bikeNOW Trading as 'Polka Dot Tour' BSB: 013440 Account: 559493942 Cheque Please make cheques payable to; bikeNOW / the trophy tour Mail to; 100 Park St South Melbourne, 3205 Is there anything you would like to tell us? Please double check your entries then click the Submit button below. We will send you a confirmation email shortly. Please click submit button once per participant, the response my take a few seconds.
* Required fields
*First Name *Last Name *E-mail Postal Address NumberStreet Suburb State Post codeCountry *Telephone Home Work Mobile *Date of birthDay Month Year *Gender Male Female *Cycling Jersey size We would like to offer you 2 jerseys and a couple of casual shirts for your trip with us, please let us know your size. :::Choose Below::: Female XX Small Female X Small Female Small Female Medium Female Large Mens X Small Mens Small Mens Medium Mens Large Mens X Large Mens XX Large Mens XXX Large *Tour Northern Italy + Giro d Italia AUD$5000 *Friends Room to myself Twin share Your own room will ass an additional $50AUD per day If twin share, who do you want share with Are there others in your group, if so, can you list them please Medical form: Required for public liability insurance! *Next of kin Name Home Work Mobile *Conditions Do you suffer from any conditions Asthma Heart Diabetes Fits or dizzy spell Respiratory problems Blood pressure Allergies If yes to any reactions, is the reaction Local (affecting more than 50cm of the area) General (affecting different parts f the body) Specify any relevant conditions below: * Conditions of Entry includes; Assumption of Risk Waiver and acknowledgement 3. Cancellations & late fees Event & route variation Refusal of entry Care of your equipment Information Photography Protecting your privacy 1. I understand that participation in this Ride is subject to the Conditions of Entry and that it is an important document which affects my legal rights. I acknowledge that a copy of the Conditions of Entry document has been made available to me. 2. I will purchase travel and make sure my policy is valid before travel I ACCEPT I (the participant) have read, understand and accept the Conditions of entry We are unable to accept your entry without your acceptance of the conditions of entry Click here to read the conditions of entry Your payment details (Credit Card by secure transaction) *Payment Details Payment required to secure your position! Payment schedule: Deposit $500 AUD upon booking, Balance is required two months before the event. (Refund policy) Payment Method Choose Below::: Direct Deposit VisaMastercardBankcardCheque Credit Card Please charge deposit of $500 to my card. Card Number Expiry 1 2 3 4 5 6 7 8 9 10 11 12 2007 2008 2009 2010 2011 2012 2013 Direct Deposit bikeNOW Trading as 'Polka Dot Tour' BSB: 013440 Account: 559493942 Cheque Please make cheques payable to; bikeNOW / the trophy tour Mail to; 100 Park St South Melbourne, 3205 Is there anything you would like to tell us?
1. I understand that participation in this Ride is subject to the Conditions of Entry and that it is an important document which affects my legal rights. I acknowledge that a copy of the Conditions of Entry document has been made available to me. 2. I will purchase travel and make sure my policy is valid before travel
I ACCEPT I (the participant) have read, understand and accept the Conditions of entry We are unable to accept your entry without your acceptance of the conditions of entry Click here to read the conditions of entry
*Payment Details Payment required to secure your position!
Payment schedule: Deposit $500 AUD upon booking, Balance is required two months before the event. (Refund policy)
Payment Method Choose Below::: Direct Deposit VisaMastercardBankcardCheque
Please double check your entries then click the Submit button below. We will send you a confirmation email shortly.
Please click submit button once per participant, the response my take a few seconds.
