READY TO REGISTER FOR THE LAKE ST CLAIR BIKE RIDE? Fill in your details below Ride Registration – 20th November 2021 First Name* Surname* SurnamePersonal DetailsStreet Address* Suburb* State*NSWACTVicQldTasSAWANTPostcode* Email* Phone* Club or Team Name (if applicable) Emergency Contact DetailsEmergency Contact Name* Emergency Contact Number* Medical conditions (if applicable) Route DistancePick up your rider bib on the day. Entries will be available on the day but cash only!Choose ride distance* 75km Ride : $80.00 : Start 8:30am 48km Ride : $60.00 : Start 9:00am 16km Ride : $30.00 : Start 9:30am Conditions: All entrants must read and agree to this declarationPlease click to read the Terms and Conditions - click here (opens in new tab) and please check the box below if you accept them to ride.Agree to terms and conditions* I agree to the terms and conditions specified above Entrant age* Entrant will be 12 years or over on the day of the ride Catering - Dietary RequirementsWe have vegetarian options for those inclined. Please indicate if you have any dietary requirementsDietary Requirements Nil Vegetarian Gluten Free DonationSupport the fantastic work of Witmore Enterprises!Donation amount Donation Amount AUDHow did you hear about us?How did you hear about us?*Newspaper (incl digital)Social MediaWord of MouthStreet AdvertisementFriendTotalTotal $ 0.00 Payment by Credit CardCredit Card MasterCardVisaSupported Credit Cards: MasterCard, Visa Card Number Expiration Date Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Security Code Cardholder Name PhoneThis field is for validation purposes and should be left unchanged.
