Amateur Registration Form

Bicycle Type*

Bicycle Make *
Geared Non-Geared    
Date of Birth * Age as on 01/01/2015
 

Race Category *

Century Race - 100 km (Fees: Rs. 500) Dream Ride - 16 kms Fees: Free upto 18 years
Rs. 200 for age above 18 years
Half Century Race - 50 km (Fees: Rs. 400)
Half Century Fixie - 50 km (Fees: Rs. 400)
 
 
 
- Photo size is not more than 800KB
- Supported Image Types : jpeg, pjpeg, jpg, gif

Personal Information

First Name * Last Name *
Address * Landmark
City/Town *
State *
Area * Country *
Pin Code * Nationality *
Gender * Male  Female
Mobile No.*
Email * Confirm Email *
 
T-shirt size: (tick any one ✓)
Extra Large (XL)/      Large (L)/      Medium (M)/      Small (S)/     
 
Contact name & number of family/friend/guardian in case of emergency *
First Name Mobile No.
 

Cycling Experience

 
      Number of years you have been cycling as a sport.
      How many century rides have you done (approx.) ?
      What is your average speed (in km/h) of cycling over 50 kms?
      What is your best cycling time (in minutes) for completing 100 kms ride?
      What is the longest distance (in km) you have cycled in one day?
      Do you have experience with cycle racing? (Yes / No)
      Which bicycle do you own? R = Road / H = Hybrid / M = Moutain / F = Fixie (non-geared bicycle)
 

Payment Information (tick ✓ any one)*

Payment Method    Online Payment Amount in Rs.
Payment Made Date: (dd/mm/yy) 
 
Amount in Words: Rupees   Only
 

Waiver(Must be signed for entry acceptance) *

I / my ward declare, confirm and agree as follows …

(I) the information given by me in this application form is true and am solely responsible for the accuracy of this information; (ii) have fully understood the risk and responsibilities of participating in the Arvind Sabarmati Cyclothon, Amdavad or any event outlined in this application (collectively “the event") and will be participating entirely at my risk and responsibilities; (iii) understand the risk of participating on a course with vehicular track, even if the course may be regulated / policed; (iv) understand that I must train to an appropriate level of fitness to participate in such a physically demanding event and have obtained a medical clearance from a registered medical practitioner, allowing me to participate in the event; (v) for myself and my legal representatives, waive all claims of whatsoever nature against any and all Sponsors of the event, Ahmedabad City, all political entities, authorities and officials, all contractors and construction firms working on or near the course, all Arvind Sabarmati Cyclothon Committee persons, officials and volunteers, Amdavad Municipal Corporation and all other persons and entities associated with the event and the directors, employees, agents and representatives of all or any of the aforementioned including, but not limited to, any claims that might result from me participating in the event and whether on account of illness, injury, death or otherwise; (vi) agree that if I am injured or taken ill or otherwise suffer any detriment whatsoever, I hereby irrevocably authorize the event officials and organizers to, at my risk and cost, transport me to medical facility or administer emergency medical treatment and waive all claims that might result from such transport and/or treatment or delay or deficiency therein. I shall pay or reimburse to you my medical and emergency expenses and I hereby authorize you to incur the same; (vii) shall provide to race officials such medical data relating to me as they may request. I agree that nothing herein shall oblige the event officials or organizers or any other person to incur any expense or to provide any transport or treatment; (viii) in case of any illness or injury caused to me or death suffered by me due to any force majeure event including but not limited to fire, riots or other civil disturbances, earthquakes, storms, typhoons or any terrorist act, none of the sponsors of the event or any political entity or authorities and officials or any contractor or construction firms working on or near the course, or any of the Arvind Sabarmati Cyclothon Committee person, official or volunteers or Amdavad Municipal Corporation, or any persons of entities associated with the event or the directors, employees, agents or representative or all or any of the aforementioned shall be held liable by me or my representatives; (ix) understand, agree and irrevocably permit Amdavad Municipal Corporation, to share the information given by me in this application, with all/any entities associated with the Arvind Sabarmati Cyclothon, at its own discretion; (x) understand, agree and irrevocably permit Amdavad Municipal Corporation, to use my photograph which may be photographed on Race Day and/or during the Arvind Sabarmati Cyclothon related events, for various purposes including promoting the Arvind Sabarmati Cyclothon, at its own discretion; (xi) shall not hold the organizers and all/any of the event sponsors responsible for loss of my application form and/or application fee in transit; (xii) understand and agree to the event terms and guidelines; (xiii)I have read and understood the rules and regulation governing Arvind Sabarmati Cyclothon, Amdavad, 2015. (xiv)Once registration has been confirmed, it will not be cancelled and race category will not be changed. (xv)If the Race Category is cancelled by Authority, Registration fees will be Refunded, or Participant may have an option to choose another Race Category. (xvi)The Participants is Compulsory Require certificate to registr in either elite or another Category (xvii)In 100/50Kms if neither of participant less than 25 in race category Organizer will have the right to cancel the race category (xviii)A Cyclist who is recognised or CFI will be considered as elite Cyclist. Cyclist will have to provide supporting documents provided /issued by CFI in this regards.(xix)Cyclist who is a Member of or Associated to any Professional cycling group/organization/club of any state/country will also be considered as an elite cyclist.(xx)A cyclist not falling in any of the above category will be considered as another cyclist.(xxi)If any cyclist falling in elite category is found to have registered in amateur his registration will be treated as cancelled and he/she will not be eligible for any Prize money in case such an incidence is found after completion of the race (xxii)The Organizer will have a right to resolve the prize money and also put a ban on his/her participants for a period which an organization dean fit