Afasic Bike Ride 2020 – registration form

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 person
- Pay £40 per person with no minimum sponsorship amount to raise
Where 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, 1,462 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.

Afasic Bike Ride 2020 – registration form
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Afasic Chiltern Hills Charity Bike Ride - 26th September 2020

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