Escape The State

6th of July. Leaving from the Rose Garden - near the base of Old Willunga Hill. At midnight. In the middle of winter. Aiming to reach NSW in 24 hours. 420 kilometres of pain. Real pain. Mark it in your calendar. The 6th of July, 2019, will be one of the hardest days of your life. This is what you are signing up for.

Full name *

First NameLast Name

Age *

Contact Number*

Email Address *

example@example.com

Home Address *

City/Suburb *

State

Postcode

EMERGENCY Contact: Name *

EMERGENCY Contact: Number *

Are you taking part as an individual, or as part of a team?*

IndividualRelay Team

If you chose 'Relay Team' to the previous question, what are the names of the two other riders in your team?

If you chose 'Relay Team', understand that all members of your team must sign-up individually. You must also be aware of where the designated checkpoints for rider changeover are located (Swan Reach and Loxton).

I understand

Have you taken part in Escape The State before?*

YesNo

Why are you taking part in Escape The State? *

e.g. keen cyclist, love a challenge, passion to help the poor

Briefly describe your experience in cycling:*

e.g. years and volume of participation

We are planning on doing three training rides before the big day. Each ride will be leaving from the Willunga Rose Garden at 2pm. Please tick the day(s) which you plan on attending:*

Saturday, 25th MaySaturday, 8th JuneSaturday, 22nd JuneOther

We are holding a dinner meeting at a venue (to be disclosed), on the 29th of June. More details will be provided closer to the date. By ticking the box below, I acknowledge that I must attend this meeting. If for some reason I cannot, I should email escapethestate.challenge@gmail.com as soon as possible.*

I understand