Waipa SuperD 2020 Race 2

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Team name   First name   Last name   Email address   Year of birth 01    01       YYYY 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921    Gender -- Male Female   Phone #   Emergency contact name   Emergency phone #   Category Choose one 40-49 50+ E-Bike 40-49 E-Bike 50+ E-Bike Open (18-39) E-Bike Under 18 Open (18-39) Under 18

Please review the waiver provided by the event organizer and click the check box below to accept it. Print waiver By signing this application you agree that: • You were 18 years or older on the most recent 1 July (if you were not, this form must be completed by your legal guardian). • If you are completing this form on behalf of a family or a junior member, you agree to each of the following points on behalf of your family/junior. • You are fully aware of the risks of cycle sports and participating in cycling events including the risks of property damage, physical injury and death. • You are responsible for deciding whether you/your family/junior are fit and healthy enough and whether your bicycle and other equipment is adequate to safely participate in cycle events. You participate at your own risk. • To the maximum extent permitted by law, the event organizer (including its agents, representatives, organizers and sponsors) will not be liable to you for any loss, damage, personal injury action, claim, costs or expenses you may suffer (to person or property) as a direct or indirect result of participating in any activity that the event organizer promotes, advertises or has any association with. • The event organizer can use (and can authorize any third party to use) photographs, video, recordings, data or any other record of your participation in any event for any legitimate purpose and you waive your rights to receive payment. • When participating in this event you will comply with any rules relevant to the event and you acknowledge that you can be refused access to the event if you engage or have engaged in any behavior the event organizer considers to be cheating or which brings the event into disrepute I accept the terms of the waiver Name of parent or guardian who approves this activity