Death Valley to LA Cycle 2025

My Details

My Contact Details

Company Name *

Occupation *

Does your company support individual fundraising? *

Yes No

Why have you chosen to do a challenge for the Electrical Industries Charity? (Please indicate whether you are open to us sharing this comment) *

How do you plan to fundraise for the minimum target of �5,000 for the Electrical Industry Charity? Please detail as much information as possible *

Have you done any fundraising for The Electrical Industries Charity before? If so, please give details. *

Do you work in the electrical industry? *

Yes No

Have you entered any other challenge events? *

Yes No

Have you done any other cycling?

Medical Questionnaire

Medical Questionnaire The information in this form will be supplied to the guide representative on the trip so they are fully aware of any medical conditions you may have. These forms have proved invaluable in the past. The details of your medical history are strictly confidential and the forms will be destroyed after the event. The event in which you will be participating is challenging and will require a good level of fitness, strength and endurance and it will involve strenuous exercise at times. It is your responsibility to ensure that you have the appropriate level of fitness. There will be personnel with first aid supplies with the group at all times, but often parts of the route will be away from main cities and hospitals (at which medical facilities may be inferior to those in the UK). We ask for your kind co-operation in this matter and invite you to phone us on should you have any queries on 020 3696 1710.

Raised blood pressure *

Yes No

Heart or circulatory disease *

Yes No

Blood clots - in particular, DVT (clot in leg) or PE (clot in lung) *

Yes No

Chest or lung disease *

Yes No

Asthma, bronchitis and / or other shortness of breath? *

Yes No

Epilepsy and / or fainting attacks *

Yes No

Diabetes *

Yes No

Digestive or bowel disorders? *

Yes No

Haematological or blood disorders *

Yes No

Cerebral disease? (e.g. stroke, head injuries, tumor etc) *

Yes No

Fracture, tendon, ligament / cartilage damage *

Yes No

Surgical operations (last 5 years) *

Yes No

Psychiatric or mental illness *

Yes No

Allergies (Hay fever, dietary, chemicals, drugs etc) *

Yes No

Heat or cold injury *

Yes No

Vertigo *

Yes No

Joint or back injuries / problems *

Yes No

Metabolic or endocrinal disorders *

Yes No

Are you pregnant *

Yes No

Physical or other disability? *

Yes No

Carrier of infectious diseases *

Yes No

Do you suffer with migraines *

Yes No

Hospitalised in the last two years *

Yes No

Any illness or conditions not already mentioned? *

Yes No

Please list any medication you are currently taking (if none, state �none�)* *

If you answer yes to any of the above questions please provide further information regarding severity & treatment currently being undertaken. *

Current Fitness Levels

Please rate your current level of fitness *

Low

Moderate

High

Extreme

Would you be interested in a training programme? *

Yes No

Social Media

Please share your Social Media handles *

Other Information

Emergency Contact (name, relationship, email and mobile number) *

T- Shirt size *

XXL

XL

L

M

S

XS

Dietary requirements *

We encourage anyone raising funds for us to follow us on social media and share, like and blog – please join us!

Facebook: www.facebook.com/electricalcharity

LinkedIn: https://www.linkedin.com/company/the-electrical-industries-charity

X: @electriccharity

Please note by submitting this application, you agree to us sharing your details in our materials and to trade media to help raise awareness of The Charity.

ELECTRICAL INDUSTRIES CHARITY 

BOOKING TERMS FOR TRAINING, EVENTS AND CHALLENGES 

BACKGROUND AND WHO WE ARE 

These are the terms and conditions that apply when EIC provides training sessions and events (whether in-person or online) to you. 

EIC is a company registered at The Electrical Industries Charity Limited, registered under company number 02726030 and having their registered office at Rotherwick House, 3 Thomas More Street, London E1W 1YZ ('we', 'our', 'us', 'EIC'). 

These terms apply to all attendees, in any capacity, at any of our training sessions and events.  Any person ('you') attending one of our training sessions or events shall be deemed to be bound by these terms.  In addition, our standards of conduct set out below apply to all attendees, speakers, and staff members at our events. 

Please read these terms carefully before booking and/or attending one of our training sessions or events.  These terms tell you who we are, how we may change or end the contract, how you are expected to conduct yourself at our events, our liability and other important information. 

Bookings and payment 

Depending on the nature of the training session, event or fundraiser you are looking to attend, you can book a place by either: 

Completing the online booking process available from the applicable event webpage; or 

Contacting a member of our team at events@eictradingco.org with details as to which event you are looking to book a place for and how many places you require. 

We accept the following payment methods for bookings for our events: 

Bank Transfer 

Stripe 

WorldPay 

Zettle 

Payment for bookings is required in full upon booking.  This means no places can be reserved without payment, and we do not accept deposits, partial payments, or payment in instalments.  Any exceptions to this must be agreed by us in writing. 

We reserve the right to make changes to our events, including changes to the venue or speakers, at any time up to the scheduled date and time of the event.  We will endeavour to inform you of any material changes in advance of the applicable event. 

Substitute guests or delegates will only be accepted subject to our prior written consent. where it is possible to do so. 

Challenge Sponsorships 

The Electrical Industry Charity will sponsor individuals, subject to our standards and requirements for the purposes of supporting the charity in it's fundraising efforts.  

Sponsorship is subject to the terms set out in these terms and conditions.  

Your obligations to attend challenges 

Where you are participating in a challenge you are expected to:  

Ensure you have an appropriate level of insurance that covers high risk sports.  

Provide medical information to ensure you are fit to participate in the challenge. 

Ensure you have followed all recommendations and advice provided either directly or indirectly by the Electrical Industry Charity 

Ensure you have a valid and up-to-date passport that is valid for at least 6 months prior to travel.  

Apply for and ensure you obtain the appropriate visa and right to travel documentation for the trip.  

Inform the Electrical Industry Charity immediately if your circumstances change for any reason.  

Please note that the Electrical Industry Charity will not be responsible or liable for your failure to comply with any of your obligations.  

cancellation 

We reserve the right to cancel any event for any reason at our absolute discretion.  If we decide to cancel an event, we will either: 

make alternative arrangements and offer you the opportunity to transfer your booking to the new event; or 

refund any amounts paid by you in full. 

Challenges are coordinated in conjunction with third parties. In certain instances, third parties may need to communicate directly with you for additional information and may, in unforeseen situations, need to cancel challenges. We are not accountable for challenges being cancelled beyond their control. 

If you wish to cancel your booking, then you must notify us in writing at events@eictradingco.org. If you cancel, you will be entitled to a full refund of all sums paid, subject to deduction of a cancellation fee, which is calculated as follows: 

Cancellation Fee Deductible - Sponsorship Booking 
- Cancellation within 20 weeks of the event - 50% of the booking costs 
- Cancellation within 16 weeks - 100% of the booking costs 

Cancellation Fee Deductible - Standard Booking 
- Cancellation within 16 weeks of the event - 50% of the booking costs 
- Cancellation within 10 weeks of the event - 85% of the booking costs 
- Cancellation within 6 weeks of the event - 100% of the booking costs 

Conditions of entry

1.	A non-refundable registration fee of �1,000 is required to participate in this event and should be paid direct to Electrical Industries Charity.
2.	You pay the non-refundable event registration fee direct to Electrical Industries Charity when you register for the event. You must raise the agreed minimum amount of sponsorship as specified �5,000, 100% of which must be sent to the charity at least 6 weeks prior to the event date and will be used to cover your costs.
3.	If you are unable to raise the minimum sponsorship required you will forfeit your right to a place on the event or you could make up the shortfall yourself.
4.	If you do not take up your place for any reason, you must notify the Charity immediately. You must contact all your sponsors to ask if they wish to make a donation or have their sponsorship returned. You must send all sponsorship forms and sponsorship money collected to your charity.
5.	All participants in this Event do so at their own risk. The Electrical Industries Charity has organised flights, accommodation, food, guides etc. In making these arrangements The Electrical Industries Charity is acting as your agent and is unable to accept liability for any loss or damage, however arising, or for cancellation of the event due to circumstances beyond their control.
6.	All participants take part at their own risk.
7.	For health and safety reasons the tour operator, ground agents and/or medical staff reserve the right to stop any person from participating 
8.	The trip operator and local staff should not be subject to inappropriate verbal or physical behaviour. In any such case we reserve the right to exclude any person from the event.
9.	You must be at least 18 years of age before the departure date of the event unless permission has been given by the Electrical Industries Charity  

standards of conduct 

These standards of conduct apply to all attendees, speakers and staff members at our events. 

You are required to conduct yourself in a professional and respectful manner whilst:  

attending our events (whether in-person or online); and  

when active on any public forum, including posting about our events on your private or your business social media pages. 

You must not engage in any form of conduct that involves harassment or offensive behaviour, or discriminate against others based on their race, gender, religion, age, disability or any other protected characteristic.  Harassment includes comments using demeaning, derogatory or discriminatory language, and comments that cause offense or harm to others.  Such conduct is not permitted during our events and such comments should not be included in posts about the event. 

Offensive or abusive behaviour towards our staff and volunteers or damage to event property (including the venue for our events and any equipment or other materials used by us to stage the event) is not acceptable. 

If your conduct breaches any of these standards then we, or the event venue, reserve the right to refuse you entry or to eject you from the event, at our or the event venue’s discretion.  You will not be entitled to any refund or compensation if you are ejected or refused entry to an event under this clause 4.5. 

If you are concerned about an individual’s behaviour at one of our events, please alert a member of staff or volunteer. 

Photography 

You agree that we may take photographs and video footage of the events as part of any promotional coverage that may capture you as an attendee, and that such photographs and videos shall not require prior approval from you prior to publishing on any format (including social media posts).  If you do not want your photograph to be taken at the event and / or to have any photographs including you published, please let us know prior to the event. 

intellectual property rights 

You acknowledge that all content, media, logos, images and other material produced for the event, used at the event, or published about the event, including any intellectual property rights subsisting therein (including but not limited to copyright, trademarks and design rights), whether registered or unregistered, shall be solely and exclusively owned by EIC, together with any goodwill therein, and you shall not acquire any rights in the same. 

data protection 

We will process any personal data we collect about you in connection with your booking and your attendance at our events in accordance with our Privacy Notice. 

Force Majeure 

We shall not be in breach of the contract nor liable for delay in performing, or failure to perform, any of our obligations under these terms and conditions if such delay or failure results from events, circumstances or causes beyond our reasonable control. 

Liability 

We shall not be liable for any costs incurred by you as a result of attending any of our events. 

You shall be liable for any losses, liability or damages suffered by EIC as a direct or indirect result of the conduct or behaviour of you at any of our events (including conduct or behaviour which is in breach of our standards of conduct in clause 4 of these terms). 

All views or opinions as expressed by the speakers, chairman or any other persons at the event (including event attendees) are the sole opinions of those persons. We therefore accept no responsibility or liability for those views or opinions of those persons. We also accept not responsibility or liability for breaches of our standards of conduct by others. 

Governing Law 

These terms and conditions, and any dispute or claim (including non-contractual disputes or claims) arising out of or in connection with its or its subject matter or formation, shall be governed by, and construed in accordance with English law. 

Jurisdiction 

EIC and you agree that the English courts shall have exclusive jurisdiction to settle any dispute or claim (including non-contractual disputes or claims) arising out of or in connection with these terms and conditions or its subject matter or formation.

I have read and understand the Terms & Conditions *

I am over the age of 18 years old *

I understand that injury, losses or damage caused or sustained during the challenge or during training is my own responsibility and at my own risk.

By completing this form you confirm you have read and agreed to the conditions and you would like to join the team in this adventure. You are committing to joining our team in raising much needed funds towards helping those in our industry who need it the most.

By participating in the Death Valley to LA Cycle Challenge for The Electrical Industries Charity you will be our ambassador and will represent and support our organisation, and you have agreed to commit to raising £5,000 for your place.

My Details

My Contact Details

My Address

Medical Questionnaire

Current Fitness Levels

Social Media

Other Information