Entry Form

39th Annual Isle of Wight Charity Sponsored Cycle Ride 1/2nd July 2023

Full Name

Phone

Address Incl Postcode

Emergency Contact Name

Emergency Contact Phone Number

T-Shirt size required

Male S

Male M

Male L

Male XL

Male XXL

Female 8

Female 10

Female 12

Female 14

Female 16

I would like an additional T-Shirt (£11)

Yes

Second T-Shirt size if different from first choice

I would like pub breakfast at the Horse and Groom, Ningwood, Sat from 10.00am. (Please note this is payable at the location)

Yes

I am making payment for the entry fee (and extra T-Shirt if selected). All Money payable to 'Cyclocruze Fund'.

Entry Fee £50

Entry Fee + extra T-shirt £61

Method of payment

Bank Transfer

Do you agree to the terms and conditions?

Yes I agree with the Terms and Conditions

Thank you for submitting your entry form.

You will shortly receive a confirmation email with a sponsorship form

If you haven't received it in a few minutes please check spam folder

Payment is by bank transfer.

Payment details - Account Number 11465171 Sort Code 40-25-24

Please identify yourself and mark as a Cyclocruze entry payment in the reference

Alternatively payment can be made through card payment during the ride.

We have now become cashless so all payments are to be made via one of the above methods

Application for entry is not guaranteed acceptance. If your application is unsuccessful, all payments will be refunded

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