Fill CTA e-Bike Registration Form

Use this to create a filled in CTA e-Bike Registration Form if you can't use the normal form. Send the completed form to oyb@ctawa.asn.aufor OYB tours or to the tour organiser for other tours.

Name:
Policy:YesNo   Have read and understood CTA e-Bike policy
Medical:YesNo   Have a medical reason
Hard:YesNo   Unable to ride in mild conditions
Couldnt:YesNo   Couldn't participate without e-Bike
Tours:YesNo   Particpated in multiple previous tours
Rigour:YesNo   Can cope with the normal rigours of OYB
Previous:YesNo   Previously used an e_Bike on OYB
Range:YesNo   Understand the range limitation of my e-Bike
Service:YesNo   e-Bike will be serviced before OYB
Distance:YesNo   Have ridden my e-Bike greater than 70 km
Weight:YesNo   Can lift my e-Bike (without battery) unassisted
Agree:YesNo   Will comply with e-Bike charging requirements
Repair:What would you do if your E-Bike broke down and was not repairable?
Comment:Other comments to support your application:
Signature:I declare I have provided the above information to describe my individual circumstances to the best of my knowledge.
Date: