BBMC Rider Registration

Please complete the form below to register for our ride day. If you have any queries, please email bftbluelightmc@outlook.com or contact 0419 898 874.

Which event date are you registering for?

Date

Have you previously attended one of our events?

How many riders?

Rider 1 Name

First NameLast Name

Age:

Rider Group

Rider 2 Name

First NameLast Name

Age:

Rider Group

Rider 3 Name

First NameLast Name

Age:

Rider Group

Rider 4 Name

First NameLast Name

Age:

Rider Group

Rider 5 Name

First NameLast Name

Age:

Rider Group

Parent / Guadian Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: 0000 000 000.

Email

example@example.com

Address (Town / Post Code)

Street Address

Street Address Line 2

Town

Post Code

Ambulance Cover Current

The purpose of this Agreement is to exclude the liability of the Provider (as defined below) to the extent permissible by law to pay damages or any other form of compensation for any personal injury or death suffered by me resulting from participating in the Recreational Activity (as defined below).
I acknowledge that the Recreational Activity involves the risk of serious injury, physical harm or death.
I also acknowledge that signing this Agreement I have done so voluntarily and that no pressure or unfair tactics have been used to persuade me to sign this Agreement and that I have done so voluntarily in the knowledge that it is open to me not to sign the Agreement and for me to elect not to participate in the Recreational Activity.
I release and forever hold harmless the Provider and any directors or officers of the Provider or any volunteer or employee of the Provider who is involved with organising the Recreational Activity from and against any claims actions, suits, proceedings or liabilities of any kind in respect of any personal injury or death suffered by me.
I also agree to indemnify the Provider and any directors or officers of the Provider or any volunteer or employee of the Provider who is involved with organising the Recreational Activity against any claims actions, suits, proceedings or liabilities of any kind in respect of any personal injury or death suffered by me.
I also agree that the liability of the Provider for any personal injury that may result from the supply of the Recreational Services (as defined below) that may be suffered by me is excluded.

Definitions:

“Participant” means the person whose name appears next Participant below.

“Provider” means Beaufort Blue Light Motorcycle Club Inc. (ABN 71 148 767 195)

“Recreational Activity” means the motorcycling activity provided by the Provider.

“Recreational Services” means the organisation of and delivery of the Recreational Activity.

Photo release statement: I also hereby consent, without further consideration or compensation, to the use of all photos or videos made of my child or family members during Beaufort Blue Light Motorcycle Club's events, for the purpose of events documentation, promotional materials or social media / web content. Further, I release the Provider and its volunteers from any liability, which may arise from the use of those photos.

Parent / Guardian Declaration: In my capacity as the parent / guardian of the Participant I make the above acknowledgements, releases, agreements and warranties on behalf of the Participant (as defined below) as if I was the Participant and further warrant that I have told the Participant that the Recreational Activity involves the risk of serious injury, physical harm or death.

Signature

Mini Track - $20.00

Main Track - $25.00

Note: registration will not be confirmed until payment is received.

Pay Now via Card
Pay Later via Bank Transfer
Pay Later (at event on arrival)

Payment

Mini Track

$20.00 AUD Quantity

Main Track

$25.00 AUD Quantity

Total

Debit or Credit Card
Credit Card Number	Security Code
Expiration Month	Expiration Year

Bank Transfer

Note: registration will not be confirmed until payment is received.

Please transfer payment to the following account:

BEAUFORT BLUE LIGHT MOTORCYCLE CLUB
BSB: 633 000
Account #: 208570549

REFERENCE: Parent Name

Beaufort Blue Light Motorcycle Club

Rider Details

Parent / Guardian

Ambulance Cover

Liability Waiver

Rider Fees

Payment