Afasic Charity Bike Ride - 10th July 2021 Please use this form to register for the Afasic Bike Ride on 10th July. The ride is a 50-mile circular route starting at Harlow Station. 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 10/07/2021)* 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, 66 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.