Please use this form to register for the Afasic Bike Rides on 15 June (Kent - 50 miles) or 7 September (Surrey - 40 miles). You can register for a single ride or for both rides. 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 15/06/19 - Kent ride) or (at 07/09/19 - Surrey ride)*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):*Choose your bike ride*You can register for the Kent bike ride on 15 June or the Surrey bike ride on 7 September. Or you can register for both rides.Kent bike ride (50 miles)Surrey bike ride (40 miles)Both bike ridesPayment (please choose an option)*Single ride: Register for £10 per person and agree to raise a MINIMUM of £50 sponsorshipSingle ride: Register for £40 per person with no minimumBoth rides: Register for £15 per person and agree to raise a MINIMUM of £75 sponsorshipBoth rides: Register for £70 per person with no minimumWhere 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 2019 Terms & Conditions of Entry Afasic Bike Ride 2019 - terms and conditions (41.3 KiB, 733 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.