350.org Bike & Picnic Registration Form

Given Name*

Last Name*

Participant Information

Address

Suburb*

Postal Code*

Email*

Confirm email

Phone

Do you have any relevant medical conditions and/or special needs
that we should be aware of? If so please provide details in
the 3 text boxes below.

1. Pertinent Details:

How many in team?

Please list names
(separate by commas)

2. Emergency Contact Name:

3. Emergency Contact Phone:

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Team Participant Information

Team Name or
Team Organiser

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I have read and accepted the

I give permission to be contacted by ParraCAN organisers.

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Under the image please copy the alpha-numeric characters into the text box.

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"We would like people to register so we know how many people to cater for but you can just turn up on the day."

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