Paris to Hayling Cycle Ride

To date, the Paris to Hayling Cycle Ride has helped to raise...

£1,279,757

Help us raise more for local & national charities & join the ride of your life!

Supported by

Entry Form

Fill out the form below then follow instructions on how to pay direct
into the ride's account.

* denotes required information

Your details
Title:
Your first name:	*
Your surname:	*
Familiar Name (how you prefer to be called):	*
Age:	*
Occupation:	*
House number/name:	*
Road/Street:	*
Town/City:	*
County:	*
Your Postcode:	*
Email address:	*
Mobile phone number:	*
Main landline phone number:	*
Emergency contact phone number for ride:	*

Your Requirements
I would like to room share with ...
My chosen jersey size is:	S M L XL XXL XXXL *
Additional Bike Ride Road Jerseys, Shorts & Training Tops required: Please indicate amount needed, sizes and gender. Shorts & Road Jerseys @ £25 each and Training Tops @ £45

Additional Information
Please provide us with as much detail as possible
How did you hear about the bike ride?
Please detail any special requests (e.g. vegetarian diet), infirmity or illness for the benefit of our insurers and organisers:
I nominate the following charity to benefit from my fund-raising for this year's event:
Contact name, address and telephone number of chosen charity:
Your Team:
I estimate my average cycling speed to be:	Slow Slowish Medium Fast *
Please provide a completion certifcate
I shall be donating my sponsorship directly to charity
I do not wish that any of the money raise be set aside for Hayling and local deserving causes
I shall send on a copy of my passport before 30th April 2012
I agree to the terms and conditions