Find us on Facebook Follow us on Twitter

Cycle Challenge Registration form

Your route
(required)

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

(required)
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.

--(required)
Your details
(required)
(required)
(required)
(required)
(required)
(required)
Contact details
(required)
(required)
(required)

Thank you for your support

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

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

As a valued supporter of Pilgrims Hospices we will treat your details very carefully and will not pass them on to any other organisations.

Emergency contact details
(required)
(required)
(required)
(required)
(required)
(required)
(required)
£
Disclaimer