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Cycle Challenge Registration form

Your route
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Registration fee for all routes: 25 (early bird rate before Wednesday 30 April 2014 - 30 after 30 April)

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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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Your details
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Contact details
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We are fully registered under the 1998 Data Protection Act so your name and address will not be disclosed to any other organization. However, we prefer to contact you by email with the information you need to enjoy this fundraising event as this is the most cost-effective form of communication for our charity. Don't worry - you can stop this at any time. We also like to send information in the post on how your support is helping Pilgrims Hospices, including Pilgrims Matters, our supporter magazine packed with inspirational stories and useful advice, but please tick the box below if you do not want to be on our mailing list.

Emergency contact details
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