Audax Ireland - Event Entry Form

Name of Event:
Riders Name:
Riders Address:
Phone:
E-Mail:
Date of Birth (if under 18 yrs) :
(Parental Consent section must be completed) / Club:
Cycling Ireland Licence Number: / Or 1-day ? / (cost €5)

I understand and agree that I participate in this event entirely at my own risk, that I must rely on my own ability to deal with all hazards and that I must ride in a manner which is safe for myself and all others. I am aware that when riding on a public highway the function of the Organiser/Controllers is solely to indicate direction and that I must decide whether the movement is safe. I agree that no liability whatsoever and howsoever arising shall attach to the Organiser, Organising Club, Cycling Ireland or any of its Committees or any Event official or Member of the Organising Club in respect of injury, loss or damage suffered by me in or by reason of the event whatsoever and howsoever caused.

Signature: / Date:
Next of Kin (Name): / Next of Kin (Phone):

PAYMENT DETAILS: I confirm that payment as below has been sent by (Please type “Yes” in one box below):

By PayPal to
By post to Andreas Voigt, 12 Brookville Park, Malahide Road, Artane, Dublin,D05 F6T2

Please ensure to say when paying (by PayPal or post), what event, and what rider you are paying for !!

Event Entry Fee (confirm from event webpage) / €
ACP (Audax Club Parisien) Medal (€5) - Optional / €
Audax Ireland Medal (€5) - Optional / €
Cycling Ireland 1-day Licence (€5) – if required / €
Total paid / €

Audax Ireland events are intended for experienced cyclists. It is expected that all entrants are capable of navigating the course from the routesheet and making repairs to their bicycles should they prove necessary. Entrants are responsible for obtaining necessary provisions for the duration of the event. The rider has sole responsibility for the decision to complete the event in the face of hazardous weather conditions, illness or injury. No support vehicles will be provided by the organiser, and entrants may only receive personal support at the control points. Front and rear lighting is mandatory for all events of length greater than 200km. Entrants should familiarise themselves with the regulations of audax events published at

PARENTAL CONSENT (for under 18’s only)

Parental consent is required for entrants under 18 years of age. Parents should read and take note of the information given above. They should also be aware that this is an individual ride and there are no leaders.

I am the Parent/Guardian of the Entrant, I have read, understand and accept the Entry Information and conditions detailed above, and give my consent to this Entry and also give my permission for my charge to ride this event:

Signature: / Date:
Print Name: