READY TO REGISTER FOR THE LAKE ST CLAIR BIKE RIDE? Fill in your details below Ride Registration – 14 September 2019 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 : $65.00 : Start 8:30am48km Ride : $50.00 : Start 9:00am16km Ride : $30.00 : Start 9:30amT-Shirt $20.00Limited stockT-ShirtNo T-ShirtSXLXXLRide Jersey $60.00Limited StockRide JerseyNo JerseySMXXLJerseys will be available on the day for pick upConditions: 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 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 MasterCardVisa Card Number Expiration Date Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged.
