Australian Extreme Obstacle Racing Yearly Membership

Australian Extreme Obstacle Racing Membership/Registration

Complete this registration form based on the club’s membership structure. Fields marked required must be completed. Provide any optional details only if applicable.
Applicant Details
First name
Surname
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Postal Address if different from above
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Age
D.O.B (Jnr, Young rider & Masters only)

MonthDayYear
Date
Emergency and Bank Details
Emergency Contact Name

First NameLast Name
Emergency Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Bank Details - BSB
Bank Details - Account Number
Bank Details - Account Name
Membership and Rider Information
Rider Level
Membership Type
Media Release Agreement
I First Name Last Name of Street Address Address Line 2 City State Zip hereby grant permission for Australian Extreme Obstacle Racing Association Incorporated or its agents and assign all rights, to use my photo, video or recordings for the purpose of promotion of Australian Extreme Obstacle Racing for all forms of media for the following but not limited to news releases, photographs, video, live feeds and website marketing.
I agree that these images, videos or voice recordings may be used for a variety of
purposes and that these images may be used without further notifying me.
I acknowledge that I will not be compensated for the use of my images, videos and
voice recordings and that Australian Extreme Obstacle Racing Association Incorporated owns the rights to the images, videos and recordings.
I hereby release Australian Extreme Obstacle Racing Association Incorporated and its agents from any claims that may arise from these uses, including without limitation, claims of defamation or invasion of privacy, infringement of moral rights, rights of publicity or copyright.
Waiver of Duty of Care

This Document is a no Duty of Care Risk Warning

By signing this document I {q3_textbox1} {q4_textbox2} of {q5_address3} individually and/or on behalf of all minor children accompanying me acknowledge that:

1. I agree to release and hold harmless AUSTRALIAN EXTREME OBSTACLE RACING
ASSOCIATION INCORPORATED, their employees, volunteers, representatives, members and
sponsors from liability for negligent acts or hazardous conditions including the uncontrolled
acts of other guests, participants and livestock, from January 1st to November 30th.
2. Participation in the Event and/or use of the Suppliers’ facilities is a recreational service for the
purposes of section 139A of the Australian Competition and Consumer Act (Cth) 2010 and a
recreational activity for the purpose of section 5K of the Civil Liability Act (NSW) 2002 The
Australian Consumer Law, the Civil Liability Act (WA), the Consumer Affairs and Fair Trading Act
(NT),
3. I participate in the Event and/or use the Suppliers’ facilities at my own risk, I acknowledge
that the Event may be a hazardous activity and involves a significant risk of physical harm and
may result in injury, loss, damage or death to me and others.
4. Participation in the Event and/or use of the Suppliers’ facility requires certain skill and
experience. I declare that I have sufficient skills and experience to be able to safely and properly
participate in the Event and/or use the Suppliers’ facilities.
5. Animals can act in sudden and unpredictable ways, especially if frightened or hurt, or if
exposed to loud or unfamiliar noises.
6. If the Event is held outdoors, there are risks to me as a result of the weather conditions,
including either extreme hot or cold weather, rain or wind.
7. In handling animals, there is a risk of suffering injury including injuries caused by the animals.
8. I am responsible for ensuring that I have and will wear equipment suitable for my safety in my
participation in the Event and/or in using the Suppliers’ facilities.
9. I am responsible for the condition of any equipment owned by myself and used by myself,
ensuring that they are appropriate for the Event and/or using the Suppliers’ facilities.
10. I waive my individual right to sue AUSTRALIAN EXTREME OBSTACLE RACING
ASSOCIATION INCORPORATED, for all claims I may have for such personal injury or death in
any way whatsoever arising from or in connection with my participation in the Event, and any
associated activities and/or my use of the Suppliers facilities.
Agreement
Type a question
Membership Fees

Please forward receipt of payment to
admin@australianextremeobstacleracing.com.au
Australian Extreme Obstacle Racing Association Incorporated
BSB: 112-879 Account Number: 460 142 835
Use Reference eg: A Citizen - membership
ABN: 75 447 325 281
Participant's Name

First NameLast Name
Parent/Guardian's Name (required if under 18)

First NameLast Name
E-Signature
Date

MonthDayYear
Date
Please verify that you are human
Should be Empty:

Australian Extreme Obstacle Racing Membership/Registration

Applicant Details

Emergency and Bank Details

Membership and Rider Information