Speed Cycle Registration Form
Everton in the Community is a registered UK charity with the charity number 1099366.
Date of Birth:
Full Address inc. Postcode:
Emergency contact name :
Emergency contact number :
Do you have any medical conditions?:
Medical condition details :
Do you have any Dietary Requirements ?:
Dietary requirements details :
Are you a regular cyclist?
How many miles a week do you cycle on average? :
Are you a member of a cycling club?
Cycling Club Name :
What pace do you think you are likely to achieve while taking part in the event?:
Do you own your own bike?
What type of bike do you intend to use?:
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