"*" 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 squadCAPTCHAEmailThis field is for validation purposes and should be left unchanged.