‘50 Great Little Miles for 50 Years of Afasic’ - 1st September 2018 Please use this form to register for the Afasic Bike Ride on 1st September 2018. You will receive a confirmation from us and a receipt from PayPal. Your name* First Last Home address* Street Address City/county Post code Email address* Daytime phone number*Evening phone number*Mobile phone number*Age (at 01/09/2018)*If under 18 must be accompanied by a 'responsible adult'.Any dietary requirements:*If you have no requirements, please type "none".Any allergies to medicine or food:*If you have no allergies, please type "none".Any medical conditions we should be aware of:*If you have no medical conditions, please type "none". Next of kin details in case of emergency during the event:Emergency contact (name)*Relationship:*Emergency contact phone (daytime):*Emergency contact phone (evening):*Emergency contact phone (mobile):*Payment (please choose an option)*Pay £10 per person and agree to raise a MINIMUM of £50 sponsorship per personPay £40 per person with no minimum sponsorship to raiseWhere did you hear about the Afasic Bike Ride?* Afasic website Facebook Twitter Newsletter Email Other Please tell us where you heard about this event* ‘50 Great Little Miles for 50 Years of Afasic’ Charity Bike Ride - 1st September 2018 Terms & Conditions of Entry Terms & Conditions - Bike Ride - 1st September 2018 (41.0 KiB, 162 hits)Acceptance of terms and conditions of entry*Please download and read the terms and conditions above. Yes, I confirm that I have read and understood the terms and conditions of the ride.