DUBBUG "Emergency" register
DUBBUG maintains online registration of those who regularly cycle with us.  The register is accessible by ride leaders in case of an accident or emergency during our rides.  The information is stored with Google Docs and is encrypted.  Access is limited to ride leaders and executive committee members.  Please contact ED m. 0400862254 or email contact@dubbug.org.au if you need more information or wish to have your data removed etc.

If you re-enter data into this form (e.g. telephone number or email changed etc), it will be used to replace any existing information.

Ride leaders are an important part of DUBBUG.  If you would like more information on becoming a ride leader please go to https://bicyclensw.org.au/ride-leaders-course 
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Email *
Your name? *
Your mobile number *
Emergency Contact (phone) *
Emergency Contact (name)
Blood Type (optional)
Medical details (anything we should be aware of?)
Medicare Number (optional)
Address
Date of Birth
MM
/
DD
/
YYYY
Insurance Membership *
We recommend Bicycle NSW see https://bicyclensw.org.au/insurance for details
Insurance Member No. (if known)
Would you be interested in becoming a Ride Leader (if not already)?
To be affiliated with Bicycle NSW we need certified ride leaders
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