LATEST NEWS
1,500 Registered for Ride the Night 2015We now have 1,500 amazing women registered to Ride the Night in 2015 for our three very special Women V Cancer charities; Breast Cancer Care, Jo’s Cervical Cancer Trust and  More...
 

APPLICATION FORM

REGISTRATION FEE: £

To register for

please complete all sections of the application form,

and click the “submit and pay online” button below to make a Secure online payment of your

registration fee . If you have any questions please call the Action for Charity events team on

01590 677854 or e-mail: events@actionforcharity.co.uk

All field marked with are mandatory.
Event Name:
Title:
Forename:
Surname:
Name by which you like to be known:
Date of birth: eg DD/MM/YYYY
Address Line 1:
Address Line 2:
Address Line 3:
Address Line 4:
Post code:
E mail Address: Please take care of spaces
Marital status:
Home tel:
Mobile tel:
Work tel:
Emloyer name:
Job title:
Employer address:
Height ( For Cycling events only ) :
T shirt size: PLEASE SELECT S / M / L / XL:
PASSPORT DETAILS
Your passport must be valid for six months after you return from the event. If you need to renew your passport or details are not currently available please advise Action for Charity of passport details at a later date.
Passport full name:
Date of issue:
Place of birth:
Nationality:
Passport expiry:
Passport Number:
Passport occupation:
NEXT OF KIN
Kin relationship:
Next of kin:
Kin address Line 1:
Kin address Line 2:
Kin address Line 3:
Kin address Line 4:
Kin day tel:
Kin postcode:
Kin Evening tel:
Kin mobile:
 
Accommodation will be shared.
Please give the name of anyone with whom you specifically wish to share with on this event
Have you done an AFC challenge before ?

If yes - please enter details in the scrolling box:
Special Dietary requirements - please indicate
any special dietary needs
How did you find out about this event ?

Declaration

I confirm that I have read the Conditions of Entry for the event and agree to abide by them. I undertake to raise and pay in the minimum sponsorship funds required by the date given and will endeavour to raise as much sponsorship as possible in addition to the minimum amount. I confirm that to the best of my knowledge my general state of health and fitness is good and I agree to complete and return the medical form that will be sent to me in my participant pack.

Data protection
Action for Charity promises to respect your privacy. The information you have provided will be used by Action for Charity, the tour operator and the charity or charities concerned for the purposes of administering the event. Your details will not be passed on to other organisations. The data we gather and hold is managed in accordance with the Data Protection Act (1998). We will not disclose or share personal information supplied by you with any third party organisations without your consent.  Action for Charity would however like to pass on your contact details to other event participants with your agreement and contact you about future charity events.  Please tick the relevant box or boxes below if you do not wish us to do that.


I do not wish my details to be passed to other event participants


I do not wish to be contacted about future Action for Charity events



REGISTRATION FEE: £
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