Individual Registration

Up in the Boondocks (2021)

If you are a member of Audax, please make sure you are logged into the portal as this will allow entry details to be filled in automatically for you.

First Name *

Last Name *

Gender *

Address *

Address 2

City *

Post Code *

Country *

State *

Phone *

Email *

You must be an Audax club member to ride. Join Audax at https://membership.audax.org.au or join for one month for $15 with your ride registration in the drop down box below.

Member of Audax Australia? *

Please bring your current Cycling Australia membership card to the start of the ride as you will need to present it to the Ride Organiser.

Choose this option if you have registered for membership on another ride and that membership will be current for this ride, or if you will purchase membership directly through https://membership.audax.org.au.

If you select this option and are not a current member the day before the ride your registration may be cancelled (without full refund) to allow a current member a spot on the ride.

Ensure you use the same e-mail address for ride registration as membership so we can match the ride registration to your membership.

Join Audax Australia Cycling Club Inc. with a one month membership. This membership does not auto-renew/charge your credit card each month

The membership will typically be activated a few days before the ride - you will receive email when the membership is activated.

If you want to register for another ride before this one (before your membership would activate) use https://membership.audax.org.au to join as a Monthly Member and the membership will activate immediately, then you can register for the rides.

The Terms and Conditions of Membership apply and by proceeding with registration you agree to these terms and conditions which contain clauses which may limit or alter liability as permissable under relevant consumer law. You have the right not to agree to the Terms and Conditions in which case you should not proceed with membership.

Membership T&Cs *

I have read and agree to the Terms and Conditions of Membership which apply to my application for Membership.

Date of Birth *

Audax Member ID *

Cycling Australia ID *

Primary Emergency Contact Name *

Primary Emergency Contact Phone *

Additional Emergency Contact Details

Ride Distance *

Medal *

No medal

Audax Australia Medal 2023 Series(+$8)

Audax Australia Medal (+$8)

ACP French Medal (+$9)

Audax Australia Patch [50km and 150km ONLY](+$5)

Fleche Opperman Medal (+10)

Audax Australia Medal - Dirt (+$8)

Randonneurs Mondiaux Medal (+$9)

Audax Australia Medal - Gravel (+$8)

Have brevet card returned after processing?

Riders carry the brevet card around the course and obtain signtures/stamps at checkpoints to prove completion. Once finished give the card to the ride organiser. This field indicates if you want the processed card back.

Return Brevet Card *

Additional Information

Please include any additional information which may be useful to the organiser such as travelling companions, allergies or medical conditions.

Comment

From time to time we may want to send you information about other rides you may be interested in. We don't want to spam you and you can opt out at any time.

Stay in Touch

Mail about Audax Events

Yes I am ok to receive email about future events

Safety Recommendations

Acknowledge Safety Recommendations *

I confirm that I have reviewed Audax Australia Safety Recommendations and acknowledge that Audax Australia strongly urges Participants to meet the recommended standards for lighting and visibility, including carrying additional front and rear lights and wearing extensive reflective material at night.

Payment Information

Coupon

Amount

Discount Amount

Gross amount

Payment Method

Credit Card (SA)

Billing Zipcode*

Credit Card Number*

Expiration Date*

Card (CVV) Code*

Card Type*

Card Holder Name*

Credit or debit card*

By clicking this checkbox, I acknowledge and accept the following Terms and Conditions

Verification code*