Genesys Pro Cycling Charity Ride

1. Registration form

Genesys Wealth Advisers charity ride - Saturday 19 February 2011

Join us and ride with members of the Genesys Pro Cycling team, while raising much needed funds for Moira Kelly's Children First Foundation.

The ride will leave from the Children First Foundation House in North Melbourne, and finish at Ievers Reserve, Flemington Road, Parkville.

Date: Saturday 19 February
Time: Registration from 12.30 pm at CFF House, 66 Chapman Street, North Melbourne
Ride starts at 1 pm

Length: 75 km approximately

Registration: $40 per rider donated to Children First Foundation. Registration fee is payable on the day in cash.

Enter now for your chance to win fabulous prizes, including team jerseys and cycling gear!

North Melbourne Rotary will be on hand with a sausage sizzle following the ride.

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* 1. Complete your personal details below

Name: *

Address 1: *

Address 2:

Suburb: *

Postal Code: *

Phone Number: *

Email Address: *

Gender: *

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* 2. Select your age group:

18-30

31-40

41-50

51-60

61+

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* 3. Select your riding skill level.

Junior (age 12 and under)

Novice

Intermediate

Advanced

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* 4. Would you like to receive information about the Genesys Pro Cycling team via email?

Yes

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* 5. Opt out

From time to time we may email you information on our services, tick here if you would like to opt out of receiving information from Genesys Wealth Advisers .

Thanks for entering to ride for charity with the pros from the Genesys Pro Cycling team.