DUBBUG "Emergency" register
DUBBUG maintains online registration of those who regularly cycle with us. The register is accessible by ride leaders in case of an accident or emergency during our rides. The information is stored with Google Docs and is encrypted. Access is limited to ride leaders and executive committee members. Please contact ED m. 0400862254 or email contact@dubbug.org.au if you need more information or wish to have your data removed etc.

If you re-enter data into this form (e.g. telephone number or email changed etc), it will be used to replace any existing information.

Ride leaders are an important part of DUBBUG. If you would like more information on becoming a ride leader please go to https://bicyclensw.org.au/ride-leaders-course
Email *
Your name? *
Your mobile number
Emergency Contact (phone)
Emergency Contact (name)
Blood Type
Medical details including allergies & medication dosage (anything we should be aware of)
Medicare Number
Home phone number
Date of Birth
Insurance Membership *
We recommend Bicycle NSW see https://bicyclensw.org.au/insurance for details
Insurance Member No. (if known)
Would you be interested in becoming a Ride Leader (if not already)?
To be affiliated with Bicycle NSW we need certified ride leaders
Clear selection
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy