USE THIS VERSION Bike Shed Membership Form

Membership application form

Townsville Bike Shed | 2021
selectability's Bike Shed provides an inclusive space for locals to connect, work on projects, go for a bike ride and improve their mental wellbeing.

It's free to join and membership allows you to borrow our bikes and use our facilities (in line with our terms and conditions).
Full name *

First name Last name
Address *

Street Address

Street Address Line 2

Suburb State

Post code
Date of birth *

Day Month Year
Date
Phone number *
0000-000-000
E-mail
example@example.com
Where did you hear about us?

selectability employee selectability website Google Facebook Radio advertisement LinkedIn
Identification

You are required to produce your identification as part of this membership form. You can do so in two ways, the first by uploading a photo of your ID below OR alternatively by showing it to a Bike Shed volunteer/employee.
Upload a photo of your ID

Browse Files

Cancel of
In case of emergency

You are encouraged to complete the below details, which enable the Bike Shed to contact this person in case an emergency arises.
Full name

First name Last name
Phone number
0000-000-000
Medical conditions
Please list all current medical conditions
Consent: For use of images and recordings

For general publishing or on selectability social media and selectability website.

I give consent to selectability to use and retain images or retain images or recordings that may identify me for use across their suite of marketing material, social media channels, website and in other promotional activities. I understand that once my image has been posted via social media or other digital platforms, it can be taken down however may retain on the virtual network.
So that your image is used in the appropriate context, do you identify as;

Aboriginal and/or Torres Strait Islander Cultural
I understand the above conditions relating to the use of my image and recordings.

I consent to the above conditions I do not consent to the above conditions
Subject to any considerations above, I understand that by giving consent selectability can use the image/recording to promote their activities. selectability may reproduce the image or recording in any form, in whole or in part, and distribute the works by any medium.

I understand that selectability;
- will not pay me for giving this consent or for the use of my image or recording
- will return or detroy images or recordings if I withdraw this consent; and
- will not infringe the rights of any third party by exercising its rights given in this consent.
Insurance

Please note insurance cover is your responsibility.

I, understand, have received a copy of the riding and safety rules and agree to abide by them. I also acknowledge that by signing this application form, the Bike Shed will not be held responsbilie in any way whatsoever, for any accident or injury I may sustain while riding with the group.
Signature *

Clear
Date *

Day Month Year
Date
Should be Empty:

Membership application form