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Cycle Challenge Registration form

Your route
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Registration fee for all routes: 25 (early bird rate before Tuesday 28 April 2015 - 35 after 28 April 2015)

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Date of birth

You must be 14 or over to take part in the Cycle Challenge. If you are between the ages of 14 and 17, a parental consent form must be completed and brought with you on the day. Under-18s must be accompanied by an adult.

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Gift Aid declaration

If you are a UK tax payer, the value of your donations can increase by 25% under the Gift Aid scheme at no additional cost to you! Please tick the box below to join the Gift Aid scheme. We can currently receive an extra 25p for every £1 you donate.

* Please be aware that you must have paid an amount of UK Income Tax and/or Capital Gains Tax at least equal to the amount of tax reclaimed by all charities and Community Amateur Sports Clubs on all your donations in the tax year (6th April one year to 5th April the next). Other taxes such as Council Tax and VAT do not qualify.

Your details
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Contact details
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Thank you for your support

Your contribution will help us continue to care for patients and their families.

From time to time Pilgrims Hospices would also like to contact you about our work and how you may support us.

Emergency contact details
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