Take Part

Cyclist’s Details

Jersey size reference

Size XS S M L XL XXL
Chest (cm) 82-86 86-94 94-102 102-110 110-118 118-126

Emergency details

Emergency contact #1

Emergency contact #2

Bike Trek Sections

Indicate the section(s) you’ll participate in:

Full Ride — Perth to Augusta (588km)
Day 1, 13 Oct — Perth to Pinjarra (Fairbridge) (90km)
Day 2, 14 Oct — Pinjarra (Fairbridge) (85km)
Day 3, 15 Oct — Pinjarra to Harvey (88km)
Day 4, 16 Oct — Harvey to Bunbury (70km)
Day 5, 17 Oct — Bunbury to Busselton (80km)
Day 6, 18 Oct — Busselton to Margaret River (80km)
Day 7, 19 Oct — Margaret River to Augusta (95km)

Nomination Fee

$30 per day OR $175 for the entire ride

*When you’ve completed sent this form, check your email to finalise your payment

You will pay via (select one):

Sponsorship Information:

The minimum sponsorship amount to be raised to participate in the Trek is $300 or $100 for one section/day. But always remember that more is better and will help more kids.

UNDER 18?

If you are under the age of 18 your parent/guardian must fill in their name and phone number below for you to be able to take part in this event:

DUTY OF CARE STATEMENT
FOR 2019 CHILDRENS LEUKAEMIA AND CANCER RESEARCH SOUTH WEST BIKE

Organisation Details/Description

The organising group will submit full details of the bike route to the Police and Main Roads Department, 1 week prior to departure.

A leading and two Trailing Escort vehicles, will accompany the cycle riders at all times. The leading and two Trailing Escort vehicles will have a flashing amber light attached to warn other road users as they approach. The last Trailing Escort vehicle will travel about (500) metres behind the second vehicle to provide adequate warning to drivers of vehicles approaching from behind.

“Bike Ride Captain” for the duration of the ride.   TO BE APPOINTED

Prior to departure on each day, a full safety check of each bicycle will be conducted, establishing the road worthiness of the bicycle for the days ride. In conjunction with the safety checks, a group safety discussion will be held, covering any known obstacles/safety hazards for the day/bad section of road etc. prior to departure.

A specified safe distance between vehicles and riders to be observed at all times. (To be established at the daily pre-departure safety meeting).

Safety gear and high visibility clothing to be worn by riders.

Two-way radios will be available for communication between the riders and support team.

For the safety and benefit of all participants riders are expected to be able to maintain a speed of at least 20 kilometers per hour for a reasonable period. Each segment of the Trek is 25 to 30km. Each day is approximately an 80 km ride.

There will be a First Aid Certificate holder in the support team. All riding will be conducted during daylight hours only. Adequate drinks to be provided for riders at all times.

The bike-route has been checked for traffic flow and density, a safe route has been chosen in preference to road condition, as bicycles are slow moving vehicles.

This Trek is a Charity ride, not a race in any shape or form, and will therefore be conducted at a leisurely pace. The group will work together to ensure each other’s wellbeing.

Contact Details:
Eric Maddock
8 Bandera Close,
WARNBRO WA 6169
Phone: 08 9593 1630 | Mobile: 0433 905 703

Email: [email protected]