Broken Hill Mountain Bike Club
Poker Race
Queen’s Birthday Long Weekend
6th - 7th June 2009
Saturday 6th
‘Golf Club Challenge’
Broken Hill Golf Club - 10am. Register from 9am
See if you can get around the course ‘under par’. After your ‘round’ enjoy a BBQ and refreshments at the Clubhouse.
Social ride Broken Hill Golf Club - 2pm
Come ride with us on some our favourite trails to see what makes this area so special.
‘Carbo Exp-load’ Broken Hill Golf Club - 6pm
Refuel after a great days riding with a few beers, pizza, and Burtie’s all you can eat pasta night.
Sunday 7th
The Mulga Hill Tavern ‘Poker Race’ Silverton Heritage Trail - 10am. Registration from 9am
Cash prizes for podium places plus the chance to go up against ‘The Dealer’ to win a one of a kind mountain bike.
For more details:
Richard Walker 0409 578 824
Shelley Clarke 0419 283 745
Photo Courtesy of Gavin Schmidt Broken Hill Barrier Daily Truth
Broken Hill Mountain Bike Club Inc.
2009 POKER RACE ENTRY FORM
• Queen’s Birthday Long Weekend • Saturday 6th and Sunday 7th June •
• PO Box 623 Broken Hill NSW 2880 • •
PLEASE PRINT (1 entry / rider)SURNAME / GIVEN NAME / MTBA No:
CLUB
/ DOB / GENDERMale Female
ADDRESS / CITY / STATE / POSTCODE
PHONE (Hm) / PHONE (Wk) / MOBILE
E-MAIL ADDRESS
ENTRY CATEGORIES
Please nominate your preferred race category: Please CircleA. Categories / Veteran (50+) / Open A (>17) / Open B (>17) / Junior (<17) / Social
B. Races / Golf Club Challenge / Poker Race
Please note: If there are insufficient entries, some categories may be merged.
ENTRY FEES
Early Bird Registration: Register by Friday 22nd May to receive a $10 discount on Senior and Social Race Fees
Total Race Fees $______/ Veteran, Open, Social / Junior
Early Bird/ Normal
MTBA Insurance $15
(For non MTBA riders) $______/ 2 Day Race / $35 / $45 / $15
Pasta Night $______/ 1 Day Race / $20 / $30 / $10
Total Payment $______ / Pasta Night / $15 / $5
Please make Cheques/ Money Orders payable to: Broken Hill Mountain Bike Club Inc. PO Box 623 Broken Hill NSW 2880
DECLARATION
Representations and Warranties I represent and warrant in favour of the Licensor as follows: I am in good physical condition and have no disability, impairment or ailment that will prevent me from engaging in the Event or that will be detrimental to my health, safety or physical condition of others while participating in the Event or while at or near the Event. Release and Indemnity I hereby release and forever discharge each of the Licenser, its officers, directors, employees, agents and contractors and sponsors, from any and all claims, suits, demands, expenses, costs, actions and proceedings of any nature whatsoever, which I, my executors or administrators or any other person has or might assert against any of them arising from, in relation to, incidental to or by virtue of any injury, loss or damage suffered or sustained by me in connection with my participation in the Event or at any time when I am near the Event. I hereby indemnify and hold harmless, and shall keep indemnified and held harmless, each of the Licensor, its officers, directors, agents, contractors and sponsors from and against all claims, suits, demands, expenses, costs, actions and proceedings of any nature whatsoever arising from, in relation to or by virtue of: (1) Any injury, loss or damage sustained by me. (2) Any injury, loss or damage suffered by any other person as a result of any act, omission, neglect or default on my part, in connection with my participation in the Event or at any time when I am near the Event. I hereby agree that the race may be cancelled due to fire, storm, rain, inclement weather, wind, route closure, or any other circumstances. I agree that only 50% of my race entry fee will be refunded in the event of race cancellation on or before 6th June 2009. I hereby agree to allow my name, results, photographs, video, multimedia or film likeness to be used for any legitimate purpose by Broken Hill Mountain Bike Club Inc. (BHMBC), the sponsors or assigns. I acknowledge that MTBA insurance covers myself for public liability and personal indemnity whilst participating in this event on 6th and 7th June 2009. I agree to wear an Australian Standards approved cycling helmet whilst riding a bike at all times during practice and the event. I agree that I am responsible for my personal accident insurance and ambulance cover. BHMBC reserves the right to refuse entry to any competitor. BHMBC reserves the right to change any team name due to conflicts with other team names or team names being of an offensive nature. I have carefully read this entry form and agree to abide by all the rules and directions of all race officials on the day. All entrants must sign as having read and understood this declaration, or if you are under 18, this must be signed by your parent or guardian.
I have read and understood the above declaration. Signature: Date:
______
RACE RECEIPT This receipt is the only receipt that will be recognised when a rider collects their number at a race meeting. This receipt is only valid for the 2009 Broken Hill Mountain Bike Club Inc. POKER RACE Weekend, 6th & 7th June 2009.Name: / ______/ Club: / ______
Golf Club Challenge / Poker Race / Veteran / Open / Junior / Social / Pasta Night
Signed by Club Official / ______/ Date / ______