Colne Valley Cycle Ride Registration Form - Sponsored by Autoparts of Braintree

Sunday 23rd May 2010

Two routes around the Colne Valley. Approx 20 miles and 40 miles.
Registration fee £20 per cyclist including a T-shirt and goody bag.

* - Required Field

Title:

First Name:

Last Name:

House Number:

Road Name:

Town/City:

County:

Country:

Postal Code:

Telephone:

Mobile Contact Tel No. on the day:

Email Address:

Date of Birth (dd/mm/yyyy):

Team Entries only

Team Name:

Team Leader:

Team Leader contact Tel No on the day:

T-Shirt Size:

Medium
Large
X-Large *

Total:

Your pack will be sent to you approximately 2 weeks prior to the event. If you have any queries do not hesitate to contact the fundraising office on 0845 2417 690.

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