Entry Form

37th Annual Isle of Wight Charity Sponsored Cycle Ride 4/5th July 2020

Full name *

Address

Postcode *

E-Mail Address *

Mobile tel no. *

Emergency contact name and tel no.

I would like an additional T-Shirt (£8)

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' (Please select late entry option if applying after 31 May)

Early entry £35

Early entry + Extra T-shirt £43

Late entry £45

Late entry + Extra T-shirt £53

Method of payment *

Bank Transfer

PayPal

Just Giving

Cash

Terms and Conditions *

I agree with the terms and conditions

The preferred method of 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 also through Paypal on the Website or Just Giving.

Card payments are also available.

Paper application forms with payment can be made through The Lord Nelson Public House, 5 High Street, Hythe, Southampton S045 6AG Tel. 02380 842169 marked Cyclocruze.

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

Your content has been submitted, you will shortly receive an email with a sponsor form.

If you wish to print the application form off and fill it in manually please use the keyboard shortcut (Ctrl + P)

This will allow you to print the current page.

Please ensure the form is placed in a sealed envelope marked up 'cyclocruze' and hand it in to a member of staff at the Lord Nelson Pub in Hythe.