Afasic Chiltern Hills Charity Bike Ride - 26th September 2020 Please use this form to register for the Afasic Bike Ride on 5th September. The ride is a 55 mile, ‘4 Counties’ circular route starting at Tring. You will receive a confirmation from us and a receipt from PayPal once payment has been completed. 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 26/09/2020)*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 £15 per person and agree to raise a MINIMUM of £50 sponsorship per personPay £40 per person with no minimum sponsorship amount 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* Afasic Bike Rides 2020 Terms & Conditions of Entry Afasic Bike Ride 2020 - terms and conditions (40.3 KiB, 729 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.