THE JOHN MACLEAN FOUNDATION JMF RIDE DAY // HUNTER VALLEY (Sep 7-9, 2018)01 PARTICIPANT REGISTRATION FORM PERSONAL DETAILS PLEASE COMPLETE EACH SECTION BELOW (PLEASE WRITE CLEARLY IN BLOCK LETTERS) Name: _________________________________________________ Daytime Tel: ( ) ____________________________________________ Address: _________________________________________________ Mobile Tel: ___________________________________________________ Suburb: _________________________________________________ P/Code: ___________________________________________________ Email: _________________________________________________ D.O.B: ___________________________________________________ Emergency Contact: ________________________________________ Contact Number: __________________________________________________ APPAREL SIZE MEN’S CYCLE JERSEY SIZE (TICK PREFERRED SIZE BELOW) WOMEN’S CYCLE JERSEY SIZE (TICK PREFERRED SIZE BELOW)

XS S M L XL 2XL 3XL XS S M L XL 2XL

MEN’S CYCLE KNICKS SIZE (TICK PREFERRED SIZE BELOW) WOMEN’S CYCLE KNICKS SIZE (TICK PREFERRED SIZE BELOW)

XS S M L XL 2XL 3XL XS S M L XL 2XL

*PLEASE REFER TO THE MEN’S SIZE CHART BELOW *PLEASE REFER TO THE WOMEN’S SIZE CHART BELOW

MEN’S MEASUREMENTS WOMEN’S MEASUREMENTS

Size Chest Waist Leg Arm Size Chest Waist Hips Leg Arm XS 86-91 71-76 39-42 26-28 XS 76-81 61-66 81-86 39-42 22-24 S 91-96 76-81 42-45 20-30 S 81-86 66-71 86-91 42-45 24-26 M 96-101 81-86 45-48 30-32 M 86-91 71-76 91-96 45-48 26-28 L 101-106 86-91 48-51 32-34 L 91-96 76-81 96-101 48-51 28-30

XL 106-111 91-96 51-54 34-36 XL 96-101 81-86 101-106 51-54 30-32 2XL 111-116 96-101 54-57 36-38 2XL 101-106 86-91 106-111 54-57 32-34 3XL 116-121 101-106 57-60 38-40

REGISTRATION FEES Registration for the 2018 John Maclean Foundation ride day is $575 (non-deductible) plus (please tick which one applies): Yes r 1. A $2,500 tax deductible donation to the John Maclean Foundation Limited; or, Yes r 2. A commitment to raise a minimum of $2,500 for the John Maclean Foundation. Upon completion of this registration form, participants will be issued a separate invoice for each payment to be made via EFT into the John Maclean Foundation Limited bank account. Upon receipt of the payments each participant will be issued with a receipt for each payment. Participants who wish to fundraise to meet or exceed the $2,500 donation amount can set up an on-line fundraising page, coordinated by the John Maclean Foundation. The registration fee for the 2018 JMF Ride Day does not include accommodation cost. Accommodation is to be booked separately with Trent Taylor of JMF via email trent.taylor@360se.com.au or by completing the accommodation booking section of this form below. MEDICAL QUESTIONNAIRE The following information is crucial in enabling appropriate care in the event of accident or illness during the event. If you answer yes to any question, please list the appropriate details. If necessary, attach a separate sheet with relevant details. 1. Do you have any current medical problems for which you are being treated by a doctor? Yes r No r Details: ______________________________________ 2. Are you on any medications? Yes r No r Details: ______________________________________ 3. Are you allergic to any medications? Yes r No r Details: ______________________________________ 4. Do you wish for the event medical staff to be aware of any specific medical condition? Yes r No r Details: ______________________________________

5. Have you ever received treatment for Hypothermia (low body temperature)? Yes r No r Details: ______________________________________ 6. Have you ever received treatment for Hyperthermia (heat stress)? Yes r No r Details: ______________________________________ 7. Have you ever received medical treatment during or following a cycling event? Yes r No r Details: ______________________________________ TERMS AND CONDITIONS The following are the terms and conditions of the 2018 John Maclean Foundation ride day. These terms are not negotiable and by registering for this event you are hereby acknowledging your acceptance of the terms and conditions of the event and your entry and participation. WARNING: This is a legal document that affects your rights, if you are uncertain or uncomfortable with some of the conditions of registration then we recommend that you obtain advice to ensure that you understand and accept the conditions of entry. I agree to participate in the 2018 John Maclean Foundation Ride Day (the “event”) on the following basis. 1. I acknowledge that cycling events involve the real risk of injury or even death from various causes including overexertion, equipment failure, dehydration, accidents with other competitors, spectators or road users, and of course weather conditions and other users. 2. I understand that the 2018 John Maclean Foundation Ride Day will be conducted on open roads and is not a closed-circuit event and the event organisors have no control over the actions of other road users, 3. I understand that I should not participate in the event unless I have trained appropriately and will be in a fit state to complete the event safely. I acknowledge that if I am aware of an existing medical condition and uncertain of my state of fitness, that a medical practitioner should verify my physical condition. 4. By participating I acknowledge and accept all risks flowing from my participation that could result in injury, loss of life, or permanent injury. Accordingly, I release all persons or corporations associated directly or indirectly with the conduct of the event from all claims, demands and proceedings arising out of my participation and I hereby indemnify them against all liability (including liability for their negligence and negligence of others) for all injury, loss or damage arising out of my participation in this event. This release shall extend to and include the John Maclean Foundation Limited, Entoure, Synergy Sports Marketing and Management Pty Ltd, John Maclean, promoters, sponsors, event marshals, support crews, directors, partners, managers, officers, agents, employees, contractors and volunteers including event medical personnel. The release and indemnity continues forever and binds my heirs, executors, personal representatives and assigns. 5. I consent to receiving any medical treatment including ambulance transportation that event directors think desirable during or after the event. 6. I have provided or attached to my entry form details of any physical or medical conditions from which I suffer that may affect my performance or be relevant if medical treatment is needed. I accept the risk of participating despite these conditions. I have supplied an emergency contact name and number, and this person is contactable during and after the event and is not another participant. 7. I understand I should acquire personal insurance cover for this event to cover me for all injury, loss or damage sustained by me. I acknowledge that I should have appropriate personal medical insurance in place at the time of this event. 8. Safety precautions undertaken by organisors, such as course supervision, safety briefings, bicycle and helmet safety checks are a service to me and other participants but are not a guarantee of safety. 9. My event registration is 50% refundable up to 5.00 pm, July 1, 2018. If I am unable to participate after this time and date, my entry fee is non-refundable. 10. Event organisors may change the event format, course or other conditions at their discretion. If that occurs, the agreement applies to the changed conditions. 11. I agree that if the event is cancelled due to storm, rain, inclement weather, winds or other “Acts of God” conditions or safety concerns, or if I do not participate in the event for any other reason, my entry fee shall be non-refundable. 12. I acknowledge and consent to photographs and electronic images taken of me before, during or after the event by official representatives of the event. I also acknowledge that such photographs and electronic images are owned by the event organisor and that the event organisor and sponsors may use the images, my name and my performance for promotional broadcasting, reporting purposes and/or other purposes at any other time by any form of media without my further consent being necessary. The event organisor is not responsible for photographs or electronic images taken by persons who are not an official representative of the event organisor. 13. I am fully responsible for the security of my personal possessions at the event. 14. I certify that I am 18 years of age or older and I have read this document and understand and accept the terms and conditions it contains. 15. I certify that I am capable of safely riding in a group of cyclists and can comfortably maintain an average minimum speed of approximately 28-30km/h on flat sections and have sufficient fitness to ascend hills at a reasonable pace without the need to walk. 16. I acknowledge that registration for the Event is on a first come first serve basis and the submission of this registration form does not guarantee registration. 17. I acknowledge that my registration will not be deemed complete until the registration fee is paid in its entirety within 48 hours of receiving an invoice from the event organisors for the registration fee. Failure to do so may void my registration. Name (Please Print) __________________________________ Signature _______________________________ Date _______________________

PLEASE COMPLETE THIS ENTRY FORM AND SCAN AND EMAIL TO TRENT.TAYLOR@360SE.COM.AU ADDITIONAL ENQUIRIES I TRENT TAYLOR I MOBILE 0411 653 699 I EMAIL trent.taylor@360se.com.au

ACCOMMODATION BOOKING Please book for me the following accommodation for the 2018 JMF Ride Day at the Crowne Plaza Hunter Valley. Please circle your booking Option and list the names of additional persons in the room (if known at the time of booking).

Option Occupancy Type Description Nights Rate Other Persons in Room 1 Single Single Occupancy in Deluxe Room Fri Sep 7 & Sat Sep 8 $575 - 2 Double Double (2) Person Occupancy in Deluxe Room Fri Sep 7 & Sat Sep 8 $575 1. 3 Twin Share Share a Deluxe Room Fri Sep 7 & Sat Sep 8 $312.50 1. 4 Family 2 Bedroom Villa for 4 Persons Fri Sep 7 & Sat Sep 8 Bespoke

Packages Available

1. 2. 3.

Accommodation costs will be invoiced separately to registration fees and donations.