Register for the Cycling Challenge

First Name

Last Name

Address Line 1

Address Line 2

City

Postcode

Telephone Number

Email

Email Confirmation

Date of Birth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

Emergency Contact

Name

Telephone Number

Relationship

T-Shirt Size

What size T-Shirt would you like?SmallMediumLarge

Disclaimer

I agree to abide by the rules of the Cyclists Highway Code

I understand that I will enter this challenge at my own risk and that no person(s) or organisation(s) will be held responsible for any accident, injury or loss to me prior to, during or after the event. This information will be held in accordance with the Data Protection Act 1998 and will be used for the purposes of administration only.

Entry fee is non-refundable.

I agree to the terms and conditions of entrance as stated in the above disclaimer.

Register by Post

If you prefer not to use an online registration form. You can download a form from here in both Acrobat PDF and Microsoft Word formats.

Registration Form

Word version. PDF version.

Ffurflen Cofrestru

Fersiwn Word. Fersiwn PDF.

Fill in a form and send it to us along with a cheque to the address below.

Len Smith
Ffestiniog 360
c/o Antur Stiniog
Units 1 & 2
High Street
Blaenau Ffestiniog
Gwynedd
LL41 3ES

Cheque's to be made payable to "Ffestiniog 360" Entry fee is non-refundable.

Sponsorship

Help us raise more money for Tŷ Gobaith Children’s hospice by collecting sponsorship from your family and friends.

If you don't want to use JustGiving you can download sponsorship forms. Front page, Additional page.