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* 1. Entry Details

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* 2. Personal Details

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* 3. UCI or Domestic Registered Team

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* 4. What are your plans for the rest of this year (2019)?

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* 5. Medical / Physio Information

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* 6. Emergency contact details while at the Camp and Race

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* 7. I have been provided with access to a copy of the Cycling New Zealand Selection Regulations 2018-2020 either directly or via the Cycling New Zealand website. I agree to comply with and be bound by the terms of that Regulation.

Selection Regulations

I acknowledge that any right of appeal and the process for such an appeal in relation to my non-selection must be exercised in accordance with the Cycling New Zealand Selection Regulations.

I acknowledge that it is a condition of my application for selection that I must complete, sign, and return by the due date to Cycling New Zealand, an Athlete Agreement.

I have met, or will by the Selection Date have met, the eligibility requirements specified in clause 4 (Eligibility) of the Cycling New Zealand Selection Regulations.

I will notify Cycling New Zealand of any changes to my contact details. I accept that any failure by me to do so may be to my detriment as any announcement regarding selection of a Team will be notified to me personally or to at least one of the contact addresses provided.

I agree Cycling New Zealand may collect personal information about me for the purposes of consideration and selection.

I may obtain independent advice on the terms of this application form and its implications, and I have been given a reasonable opportunity to do so.

* If the rider is under the age of 18 years as at the date of completing this form, the form must also be completed by the parent(s)/guardian(s) of the rider in the space provided below.

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