Neuroscience Sponsored Bike Ride

Sunday, 29 September 2024, 09:00 - 16:00

First Name *

Last Name *

Date Of Birth *

Gender *

Email *

Phone Number *

Mobile Number *

Please provide us with an Emergency Contact

Name*

Contact Number*

Relationship*

Address Line One *

Address Line Two

Town/City *

County

Postcode *

Country *

Please tell us a little bit about your cycling experience and how long you approximate it will take you to ride 40 miles *

Would you like to receive a fundraising pack? *

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If yes would you like to receive your pack by post or email?

Do you consent for us to use photos/videos of you in our marketing and social media as part of this event? *

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