Everyday Hero Australia: 2012 Half-Smiddy Challenge

Please choose

Registration Fee - $650.00
Day Rider Registration - $200.00

Items

Partner Package

If you wish to have your partner join us for the duration of Half-Smiddy please select here. You will receive separate accommodation and your partner will be included in all planned meals.
- Partner Package
- @
- $350.00

Promo Code

Optional - Only applicable if you have a promotional code to subsidise your registration fee.

Code:

Personal Details

Please complete your personal information. Your date of birth is required for verification of age specific events.

Salutation:
First name:
Last name:
Date of Birth:*
Gender:
Email:
Email Confirmation:
Phone:

Contact

Please complete your contact information.

Address 1:
Address 2:
Suburb/Town/City
State/Province/Region
Postal Code
Country:

Questions

Q.01 Jersey Size - Select:
Q.02 Knicks Size - Select:
Q.03 Would you like bib shorts?
Q.04 Gloves Size - Select:
Q.05 Helmet Size - Select:
Q.06 T-shirt Size - Select:
Q.07 Blood Type
Q.08 Allergies
Q.09 Please let us know if you have any special dietary requirements.
Q.10 Insurance. All riders taking part in the Half Smiddy Challenge for Cancer must have personal insurance to cover you for injury, loss or damage. You must either be a member of either Cycling Australia or one of its state associations, such as Bicycle Queen
Q.11 Emergency Contact Name *
Q.12 Emergency Contact Phone Number. *
Q.13 Occupation
Q.14 Please provide your company name here

Terms & Conditions

Terms & Conditions "Half Smiddy" means the Smiling for Smiddy ride on 2-6 May 2012 departing Brisbane and returning to Brisbane or any part of the route there of to raise money for cancer research. “Foundation” is Mater Foundation Brisbane, Queensland. YOUR SUBMISSION OF THIS FORM IS YOUR ACKNOWLEDGEMENT OF THE ACCEPTANCE OF THE TERMS & CONDITIONS OF PARTICIPATION IN THE HALF SMIDDY. I wish to participate in the Half Smiddy and understand that participation has inherent risks, including risks to personal heath arising from the physical nature of the Half Smiddy, falling or being knocked off my bike, risk of collision with vehicles and other objects. I am aware of the fitness level required to undertake the Half Smiddy and certify that I am physically capable of participating in the Half Smiddy and accept all risks associated with it. I understand and acknowledge that my participation will: 1. be voluntary; 2. not be paid for by the Foundation; and 3. if I am employed by any of the Foundations, not be in the course of my employment at the Foundation. In consideration of the Foundation accepting my entry into the Half Smiddy, I absolutely release and waive any claim I might otherwise have had against the Foundation and any officials or volunteers associated with the Half Smiddy in respect of any injury, loss or damage I might suffer arising from my participation in the Half Smiddy, including any loss or damage arising from a breach of contract and/or negligence by the Foundation or any officials. I will also indemnify and hold harmless the Foundation against any loss or damage claimed against it by third parties as a result of any such claim made by me during the Half Smiddy or arising from any action or negligence caused by me during the Half Smiddy. I acknowledge that upon completion and acceptance of this entry registration, AUD$250 (including GST) of the entry fee is non-refundable up to 4.59pm Friday 2 March 2012, and the total entry fee is non-refundable after 5pm on Friday 2 March 2012. I hereby consent to receive medical treatment that may be deemed advisable in the event of injury, accident or illness during the Half Smiddy. I hereby grant to the medical director(s) of the Half Smiddy and his or her agents, affiliates and designees, access to all medical records (and physicians) as needed and authorise medical treatment as needed. I agree to be responsible and assume liability for any and all costs incurred as a result of training for and/or participation in the Half Smiddy, including but not limited to ambulance transport services, hospital stays, medical care and treatment, and physician and pharmaceutical goods and services, except for care and treatment covered by my insurance. I agree to indemnify and hold harmless the Foundation and related parties from all liability for such costs. I hereby grant to the Foundation the right, permission, and authority to use my name, image, voice, and/or likeness, without compensation, captured during the Half Smiddy and its affiliated entities or contractors, and/or the media in any photographs, videotapes, CDs, DVDs, broadcast, telecast, podcast, webcast, recordings, motion pictures, commercial advertisement, promotion materials, and/or any other record of this Half Smiddy for any purpose whatsoever. I affirm that I am 18 years of age (or will be at the time of the Half Smiddy) or older and have read and understood what is expected of me and I agree to adhere to the direction of the Challenge Director at all times. I acknowledge that I am required to fundraise or personally meet a minimum of $3,000 in donations for the Foundation as part of my participation. I will demonstrate $3,000 in funds raised by 30 April 2012 or meet any shortfall to secure my participation in Half Smiddy. The Challenge Director reserves the right to suspend my involvement in Half Smiddy should I not be able to demonstrate $3,000 raised by 30 April 2012. I acknowledge that the Foundation reserves the right to refuse my application to register. Should my application be refused my full registration fee will be refunded to me. Each participant will automatically receive an online fundraising webpage as a part of the registration process either as an individual or as a part of a team. All participants agree to Everyday Hero terms & conditions which can be viewed in detail at http://www.smiddyfundraising.com.au/event/Half Smiddy/terms_and_conditions

I have read and understand the terms and conditions.*

Registration Summary

Total

$ 0.00 AUD

Partner Package

Registration Summary