Afasic Bike Ride 2020 – registration form

Afasic Charity Bike Ride - Saturday 4th September 2021

Please use this form to register for the Afasic Bike Ride on 4th September. The ride is a 20-mile circular route starting at Victoria Park. 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 04/09/2021)*

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 2021
Terms & Conditions of Entry
Bike_Ride_Terms__Conditions.doc (27.5 KiB, 212 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 Charity Bike Ride - Saturday 4th September 2021

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