Chris Spin 2017 Application Form

Name

Email - Invalid email address

Mobile number

Emergency contact name

Emergency contact number

I would like to take part in the
52 mile ride
16 mile ride

Age
I am over 16 years old
I am under 16 years old

Disclaimer
I understand that the event organisers and Prostate Cancer UK cannot be held responsible in any way for loss or injury to me, or any other party, however arising or for any property lost or damaged as a result of my participation in this charity event. I declare that I am medically fit and understand that I enter this event at my own risk.

If under 16 years old - Name of Parent/Guardian

If under 16 years old - Parental Disclaimer
I am the parent/guardian of the above-named child and I am happy with their participation in this charity event and endorse the above declaration on their behalf.