Cycle Challenge Registration Form

Join us for the Pilgrims Hospices Cycle Challenge on the 2nd May 2027

This form can be used to register up to 4 people at a time.

Lead Participant Details

Title*

Other Title*

First name*

Surname*

Gender*

Date of birth*

Address*

Address Line 1 Address Line 2 Town/City County Postcode Country

Lead Participant Contact Details

Mobile number*

This should be the same number as the mobile you will have with you during the event.

Email address*

Must be checked regularly. This is the most effective way for us to communicate event information with you.

Enter Email Confirm Email

By submitting this form, you consent to be contacted by email for the purpose of this event. If you'd like to receive emails about other exciting ways to support Pilgrims Hospices or with news about our work, please tick the box below.

Email Opt In

I am happy to receive emails where possible

You can update your contact preferences at any time by calling our Supporter Relations Team on 01227 782062 or by writing to us at Pilgrims Hospices, Supporter Relations, 56 London Road, Canterbury, Kent, CT2 8JA.

We are registered under the Data Protection Act and will never share, sell or swap your details with any third party for the purposes on their own marketing or the monetising of your data.

Lead Participant Event Details

Team Name

Route (You must complete your chosen route by 7pm at the latest)*

Emergency contact name*

Emergency contact number*

Are you taking part in memory of a loved one?

Where did you hear about this event?*

Other*

Would you like to register a second person?

Yes

Participant 2 - Details

Title*

Other Title*

First name*

Surname*

Gender*

Date of birth*

(Under 18s must be accompanied by a participating adult and supervised at all times)

Address (Participant 2)*

Same as Participant 1

Address Line 1 Address Line 2 Town/City County Postcode

Participant 2 - Contact Details

Mobile number*

This should be the same number as the charged mobile phone they will have with them during the event.

Email address

This must be different to the lead participant

Participant 2 - Event Details

Team Name

Route (They must complete their chosen route by 7pm at the latest)*

Emergency contact name*

Emergency contact number*

Are they taking part in memory of a loved one?

Would you like to register a third person?

Yes

Participant 3 - Details

Title*

Other Title*

First name*

Surname*

Gender*

Date of birth*

Under 18s must be accompanied by a participating adult and supervised at all times.

Address (Participant 3)*

Same as lead participant

Address Line 1 Address Line 2 Town/City County Postcode

Participant 3 - Contact Details

Contact mobile number*

This should be the same number as the charged mobile phone they will have with them during the event.

Email address

This must be different to the lead participant

Participant 3 - Event Details

Team Name

Route (They must complete their chosen route by 7pm at the latest)*

Emergency contact name*

Emergency contact number*

Are they taking part in memory of a loved one?

Would you like to register a fourth person?

Yes

Participant 4 - Details

Title*

Other Title*

First name*

Surname*

Gender*

Date of birth*

Under 18s must be accompanied by a participating adult and supervised at all times.

Address (Participant 3)*

Same as lead participant

Address Line 1 Address Line 2 Town/City County Postcode

Participant 4 - Contact Details

Contact mobile number*

This should be the same number as the charged mobile phone they will have with them during the event.

Email address

This must be different to the lead participant

Participant 4 - Event Details

Team Name

Route (They must complete their chosen route by 7pm at the latest)*

Emergency contact name*

Emergency contact number*

Are they taking part in memory of a loved one?

Merchandise

Show your support with an official Pilgrims Hospices Cycle Jersey and Neck Buff

Pilgrims Hospices Cycle Jersey

The Pilgrims cycle jersey is a stylish, quality garment, packed with great features such as a zipped valuables pocket, full length zip and silicone waist gripper. Made from recycled material. Available in sizes XS, S, M, L, XL, XXL. Jersey sizing guide

Would you like to add any jerseys to your registration?

Yes

Please indicate the number of Series 1 Jerseys you would like to add to your registration.

Price: £ 45.00

Size(s) of Series 1 Jersey required

Please indicate the number of Series 2 Jerseys you would like to add to your registration.

Price: £ 50.00

Size(s) of Series 2 Jersey required

Pilgrims Hospices Neck Buff

The Pilgrims neck buff is made from recycled material and a multifunctional accessory suitable for all conditions and purposes. Benefitting from Hot & Cold technology, designed to keep you warm when it’s cold, and to wick moisture away when it’s hot with exclusive Qwick-Dri™ technology. The lightweight nature of the fabric ensures it’s comfortable to wear for prolonged period of time.

Would you like to add any neck buffs to you registration?

Yes

Please indicate the number of Pilgrims neck buffs you would like to add to your registration.

Price: £ 5.00

Make a donation

I would like to add a donation to my entry of:

Please enter your chosen donation amount:*

Gift Aid*

Increase the value of your gift by 25%

Yes. Please treat all donations I make now, in the future, or have made to Pilgrims Hospices for the past 4 years as Gift Aid donations until further notice. I am a UK taxpayer and understand that if I pay less income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference. I understand that Pilgrims Hospices will reclaim 25p of tax on every £1 that I have given.
I am not a UK Taxpayer

Terms and Conditions

T&C's*

Yes, I have read the Terms and Conditions of entry.

Disclaimer

I understand that I take part in the Pilgrims Cycle Challenge at my own risk on public roads and that the organisers will not be liable for any injury or illness except where injury or illness is caused by their negligence and they are legally liable. I agree to abide by any terms and conditions of the event as agreed by the organisers. I undertake at all times to behave responsibly. I agree to follow any and all safety instructions given by the organisers before and during the event. By taking part in the event, I agree to Pilgrims Hospices, and their official photographers, using my name and any footage or photographs taken during my participation to be used in any future promotional material. (Please tick to indicate that you have read and agree to the disclaimer)*

I agree

Total

£ 0.00