Cycle instead in spring Bike to Work Challenge

Bike to Work Challenge Registration Form

Win an iPod Shuffle.
If you sign up now you and the nominated person who invited you to join the Challenge will each go into the draw to win an iPod Shuffle. Two iPod Shuffles to be won. Just enter the name on the entry form below. Prizes are drawn on Wednesday October 19.

The cycle instead bike to work challenge is a free event open to workplaces, companies, government departments, organisations, school & student groups, social groups and individuals in Western Australia. The aim of the challenge is to encourage more people to cycle to work and make cycling a part of their everyday life.

Username*
Don't use your full name as username, as Username is displayed on your forum post. No numbers are permiited in your username. Alphabetical letters only.
Email*
Password *
First Name*
Last Name*
First Letter of Last Name*
Only your first name and the first letter of your last name will shown on the web to identify you. Your Company and where you ride from and ride to will also be displayed.
If you don't have a Company or workplace just type Friend in the Company box.
Company*
Address
City or Town
State*
Postal Code
Country*
Telephone
Birth Date
Male or Female *	Female Male
Novice or Experienced *	Novice Experienced
Cycling From*
Suburb or Train Station etc. Don't use a personal address.
Cycling To*
WIN an iPOD SHUFFLE: For a chance to win an iPod Shuffle nominate who invited you to join the Bike to Work Challenge. Both yourself and the nominated person will be placed in the draw to win one of two iPod Shuffles.
I was recruited by:
CONDITIONS OF ENTRY: All participants should note: It is the responsibility of each participant to ensure they are physically and medically fit to participate in the Bike to Work Challenge. It is, in the consideration of and as a condition of acceptance of any entry in the Bike to Work Challenge events for each person, their heirs, executors, administrators and employers hereby waive all and any claim, right of cause of action which they might otherwise have for arising out of loss of life, injury, damage or loss of any description whatsoever which may be suffered or sustained in the course of or consequent upon the persons entry or participation in the event. This waiver, release and discharge shall be and operate separately in favour of all persons, corporations and bodies involved or otherwise engaged in promoting or staging the event and the servants, agents, representatives and officers of any of them. Ensure your bicycle is in good working order and fit to ride. Wear an approved bicycle helmet. Have FUN, ride safely within the road rules and within your own physical capabilities.
I HAVE READ THESE CONDITONS OF ENTRY AND AGREE WITH THEM. *	Agree
Account Name
Attention: To maintain maximum security of your private information, details of your email address, last name, address, city, telephone, birth date and sex are not displayed on the web at all. If you would like to update any of these details please email: corpchal@iinet.net.au