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Registration Form for Team

Questions marked ( * ) are mandatory
Contact Details
Name*
First Last
Date of Birth*
Date Format: MM slash DD slash YYYY
Gender*
- Male
- Female
Your Age:*
Must be 18 years of age prior to event .
Email*
Mobile Phone*
Address
Street Address Suburb City State Post Code Country
Jersey Size
Bib Size
If relevant
T-Shirt Size
If relevant
Emergency Contact Details
Emergency Contact Name*
Emergency Contact Number*
Relationship with the Contact*
Friend/partner etc.
Cycling Information
Entry Fee
Price: $ 795.00
Are you a member in any existing Team?
- Yes
- No
Name of the Team
Your Group Registration ID is sent to the captain of your Team in the confirmation email.
Fundraising Goal:
Minimum fundraising goal for an individual is $3000 and for the group it's $25,000.
Please upload your photo
Are you a member of Cycling Australia?*
It is mandatory for all participants in the Beach to Bush Ride to be a member of Cycling Australia. Our priority is your safety.
- Yes
- No
It is a condition of this ride that all participants have a current membership with Cycling Australia. Please ensure you join prior to this event and provide us with your membership number. You can send your membership number to ride@beachtobushride.com.au
To apply for membership in Cycling Australia: Click Here
Please enter your current Cycling Australia Membership number.*
Do you currently ride a bike?*
- Yes
- No
Do you wish to create a team?
- Yes
- No
How far would you ride a week?*
What is your current average speed when riding?*
Which peloton speed would you like to ride for the event?*
Dietary Information
Do you have any food allergies?*
- Yes
- No
Describe your food allergies*
Do you have any special dietary requirements?*
- Yes
- No
Please specify your dietary requirements*
Do you have any medical conditions we need to be aware of?*
Payment Details
Total
$ 0.00
Credit Card*

American Express
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name
Agree/ Disagree
* Please read all the documents attached before submitting the form. To participate in the Beach To Bush Ride, you must agree to all the terms and conditions.
- Terms and Condition
- Cycling Australia Membership Terms and Conditions
I agree*
- I agree to the Terms and Conditions listed above.
- I agree to all Terms and Conditions of Cycling Australia Memebership
Group Registration ID:
Team Name

TWILIGHT FAMILY FUN NIGHT

Now that you have completed the ride it’s time to let your hair down and experience real bush hospitality. You’ll be the stars of the evening as we celebrate your efforts in raising much needed funds for our drought stricken farmers and rural communities in NSW. There will be live music, market stalls, food …

FUNDRAISING

The Beach To Bush aims to raise substantial funds for Rural Aid’s programs and initiatives. Money raised will help fund Buy a Bale, Farm Rescue, Rural Counsellors and much more. Participants in the Beach to Bush ride are required to achieve a minimum fundraising commitment of $2,000 per person…

Registration Form for Team

Contact Details

Emergency Contact Details

Cycling Information

Dietary Information

Payment Details

Agree/ Disagree

TWILIGHT FAMILY FUN NIGHT

FUNDRAISING