Cycle Challenge Registration Form 2025 Join us for the 15th Anniversary of the Pilgrims Hospices Cycle Challenge on the 4th May 2025! This form can be used to register up to 4 people at a time. Lead Participant Details Title*Please selectMrMissMrsMsMxDrOtherOther Title*First name*Surname*Gender*Please selectMaleFemaleNon-binaryTransgenderPrefer not to sayDate of birth* DD slash MM slash YYYY Address* Address Line 1 Address Line 2 Town/City County Postcode Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 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 NameRoute (You must complete your chosen route by 7pm at the latest)*Please SelectThe 15th Anniversary - 15 miles (£25 Early Bird)The Circuit - 30 miles (£30 Early Bird)The Classic - 50 miles (£40 Early Bird)The Challenge - 75 miles (£40 Early Bird)The Century - 100 miles (£50 Early Bird)The Epic - 125 miles (£60 Early Bird)The 15th Anniversary - 15 miles (£30 Standard Entry) (0 spaces left)The Circuit - 30 miles (£35 Standard Entry) (0 spaces left)The Classic - 50 miles (£45 Standard Entry) (0 spaces left)The Challenge - 75 miles (£45 Standard Entry) (0 spaces left)The Century - 100 miles (£55 Standard Entry) (0 spaces left)The Epic - 125 miles (£65 Standard Entry) (0 spaces left)Emergency contact name*Emergency contact number*Are you taking part in memory of a loved one?Do you have a sponsorship target you would like to achieve?Please select£100£250+£350+As much as I canWhere did you hear about this event?*Please selectPoster/flyer/bannerSocial mediaInternet searchWebsiteWord of mouthEmailPilgrims Matters magazinePilgrims volunteerOtherOther*Would you like to register a second person? Yes Participant 2 - Details Title*Please selectMrMissMrsMsMxDrOtherOther Title*First name*Surname*Gender*Please selectMaleFemaleNon-binaryTransgenderPrefer not to sayDate of birth*(Under 18s must be accompanied by a participating adult and supervised at all times) DD slash MM slash YYYY 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*Must be checked regularly (this is the most effective way for us to communicate with them) Enter Email Confirm Email Participant 2 - Event Details Team NameRoute (They must complete their chosen route by 7pm at the latest)*Please SelectThe 15th Anniversary - 15 miles (£25 Early Bird)The Circuit - 30 miles (£30 Early Bird)The Classic - 50 miles (£40 Early Bird)The Challenge - 75 miles (£40 Early Bird)The Century - 100 miles (£50 Early Bird)The Epic - 125 miles (£60 Early Bird)The 15th Anniversary - 15 miles (£30 Standard Entry) (0 spaces left)The Circuit - 30 miles (£35 Standard Entry) (0 spaces left)The Classic - 50 miles (£45 Standard Entry) (0 spaces left)The Challenge - 75 miles (£45 Standard Entry) (0 spaces left)The Century - 100 miles (£55 Standard Entry) (0 spaces left)The Epic - 125 miles (£65 Standard Entry) (0 spaces left)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*Please selectMrMissMrsMsMxDrOtherOther Title*First name*Surname*Gender*Please selectMaleFemaleNon-binaryTransgenderPrefer not to sayDate of birth* DD slash MM slash YYYY 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*Must be checked regularly (this is the most effective way for us to communicate with you) Enter Email Confirm Email Participant 3 - Event Details Team NameRoute (They must complete their chosen route by 7pm at the latest)*Please SelectThe 15th Anniversary - 15 miles (£25 Early Bird)The Circuit - 30 miles (£30 Early Bird)The Classic - 50 miles (£40 Early Bird)The Challenge - 75 miles (£40 Early Bird)The Century - 100 miles (£50 Early Bird)The Epic - 125 miles (£60 Early Bird)The 15th Anniversary - 15 miles (£30 Standard Entry) (0 spaces left)The Circuit - 30 miles (£35 Standard Entry) (0 spaces left)The Classic - 50 miles (£45 Standard Entry) (0 spaces left)The Challenge - 75 miles (£45 Standard Entry) (0 spaces left)The Century - 100 miles (£55 Standard Entry) (0 spaces left)The Epic - 125 miles (£65 Standard Entry) (0 spaces left)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*Please selectMrMissMrsMsMxDrOtherOther Title*First name*Surname*Gender*Please selectMaleFemaleNon-binaryTransgenderPrefer not to sayDate of birth* DD slash MM slash YYYY 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*Must be checked regularly (this is the most effective way for us to communicate with you) Enter Email Confirm Email Participant 4 - Event Details Team NameRoute (They must complete their chosen route by 7pm at the latest)*Please SelectThe 15th Anniversary - 15 miles (£25 Early Bird)The Circuit - 30 miles (£30 Early Bird)The Classic - 50 miles (£40 Early Bird)The Challenge - 75 miles (£40 Early Bird)The Century - 100 miles (£50 Early Bird)The Epic - 125 miles (£60 Early Bird)The 15th Anniversary - 15 miles (£30 Standard Entry) (0 spaces left)The Circuit - 30 miles (£35 Standard Entry) (0 spaces left)The Classic - 50 miles (£45 Standard Entry) (0 spaces left)The Challenge - 75 miles (£45 Standard Entry) (0 spaces left)The Century - 100 miles (£55 Standard Entry) (0 spaces left)The Epic - 125 miles (£65 Standard Entry) (0 spaces left)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 JerseyThe 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. Available in sizes XS, S, M, L, XL, XXL. Jersey sizing guideWould 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. Quantity Price: £ 45.00 Quantity Size(s) of Series 1 Jersey requiredPlease indicate the number of Series 2 Jerseys you would like to add to your registration. Quantity Price: £ 50.00 Quantity Size(s) of Series 2 Jersey requiredPilgrims Hospices Neck BuffThe Pilgrims neck buff is 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. Quantity Price: £ 5.00 Quantity Make a donation I would like to add a donation to my entry of:Please select£10 could pay for a patient's meals for the day£20 could provide a physiotherapy session to help a patient stay active and enjoy time at home with their family£30 could enable our Community Team to hold a consultation with a patient in their own home.£45 could pay for one-on-one counselling for someone struggling to cope with the loss of a loved one.Other amountPlease 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 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 Total £ 0.00