Cycle4Cynthia 2024

My Details

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Last Name *

Date Of Birth *

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Address Line Two

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My Family Details

Please give the names and date of births of your family members joining you

Name of Adult 2 *

Date of Birth *

What distance are they signing up for? *

Name of Child 1 *

Date of Birth *

What distance are they signing up for? *

Name of Child 2 *

Date of Birth *

What distance are they signing up for? *

Event Details

What distance are you signing up for? *

Emergency Contact Name *

Emergency Contact Number *

Please give details of any medical conditions *

Donations

We understand that fundraising isn't for everyone, so if you would prefer to make a donation, you can do this at the checkout. Your donation will help us to continue to make a difference.

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Gift Aid Declaration:

* I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference.

Disclaimer

On entering the event, I understand that the organisers cannot be held responsible for any injury or loss sustained by me however caused and arising from my participation in Cycle4Cynthia. I agree to abide by the Highway Code, the Countryside Code and the Event Rules. *

Keeping in Touch

We would like to keep in touch occasionally with news of our work and fundraising activities, including Cycle4Cynthia, using the contact details you have supplied. If you prefer not to be contacted this way, please tick here

I opt in for email contact by Cynthia Spencer Hospice

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If you have a discount code, enter it here

My Details

Create or Join a Team

My Contact Details

My Address

My Family Details

Event Details

Donations

Disclaimer

Keeping in Touch

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