TRBUG Membership Application
Toowoomba Region Bicycle Users Group Inc.
Email address *
Name *
Your answer
Residential Address *
Your answer
Mobile Phone Number *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Mobile Phone Number *
Your answer
Bicycle Queensland Member Number *
Your answer
Do you agree to your photo being used for promotional material e.g. the TRBUG Inc. Facebook, ride reports etc. *
Declaration *
I agree to be bound by the rules of incorporation. I understand that I am required to be a member of Bicycle Queensland to obtain personal Rider Accident Insurance, before being accepted as a member of TRBUG Inc. I understand that participation in TRBUG Inc rides and activities is solely at my own risk. I accept that it is my responsibility to have all the necessary safety equipment for riding and that my bicycle is in a safe operating condition. I agree to abide by the state road rules at all times when riding.
Required
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Toowoomba Region Bicycle Users Group. Report Abuse - Terms of Service