Information :: Alecia Dodson, Administration Manager,  Moyne Health Services, P O Box 93, Port Fairy, 3284   ABN 30 586 278 991   Telephone BH: (03) 5568 0100 Fax: (03) 5568 0158  Or Hester Woodrup (03) 5568 1307  Email: info@murraytomoyne.com.au  Registration PART A Please complete the form below. On completion, you will receive an automated email with all the details you have submitted. You are then required to: Print out the email you receive Have your CEO (or principle) authorise (sign) the form Stamp the imprint of your organisation on the email/form Attach a cheque for the full entry fee to the email/form you receive for the number of riders and support crew nominated to secure your registration. Please make cheques payable to "Moyne Health Services" Note : This form becomes a tax invoice upon payment. Mail the email/form to the address above (address supplied in the email you receive). You will then be mailed PART B of the Registration Form for completion. Please complete the form to register your team. Name of Team Name of Hospital/Health organisation team is riding for Name of CEO/other senior authorised representative of your organisation Title/position of this person. eg: CEO, etc A condition of entry is that all funds raised are donated to the above named health related organisation. Forms returned without the official organisation imprint will be returned to the Team Manager thus jeopardising your team's entry. If your team participated in the 2008 event, please also complete this section Team number in 2008 Organisation Name of CEO/authorised person Title/position of this person. eg: CEO, etc Amount raised in 2008 Team Contact Details Name Address Phone BH Phone AH Fax Email Number of riders to be registered (Suggested number 8: min 6, max 12) Number of riders @ $77.00/rider = (Incl GST) Number of support crew to be registered Number of support crew @ $77.00/person = (Incl GST) Total for both (above) (Incl GST) Safety Officer Name Address Phone BH Phone AH Fax Email Full entry fee for the number of riders and support crew nominated must accompany this form (that you will receive by email) to secure your registration.   Please indicate which of the options you consider to be the ability of your team. For you to avoid being continually stopped on the ride because your team is made up of experienced cyclists or alternatively lagging behind because of an inexperienced team made up of slower cyclists please consider these alternatives.     Fast       Moderate       Slow     Preferred starting point. Each box must be numbered 1,2,3     Mildura:       Echuca:       Swan Hill:       • home   • history   • the ride   • team organisation   • training tips   • registration   • team news   • calendar of events   • gallery   • faq's   • support crews   • ride maps   • donations   • committee   • sponsors   • merchandise Site development © Copyright Site sponsored by