"*" indicates required fields Parent/GuardianFirst Name* Surname* Email* Phone* Relationship to rider*Parent, Sibling, Grandparent etc. Would you like to add a second contact?* Yes No Second ContactFirst Name* Surname* Email* Phone* Relationship to rider* RiderFirst Name* Surname* Date of Birth* DD slash MM slash YYYY Gender*Please SelectFemaleMaleOtherOther* Do you have an AusCycling Membership?*Please SelectYesNoAusCycling Number* AusCycling Expiry* Medical Conditions To Be Aware Of* Permission To Perform First Aid*Please SelectYesNoPermission To Send For Ambulance*Please SelectYesNoMedia Permission*Please SelectYesNoI have signed the waiver*Please SelectYesNoEstimated Skill Level*1 – Beginner23 – Intermediate45 – AdvancedSchool attendingFor youth development squad CAPTCHANameThis field is for validation purposes and should be left unchanged.