Rotary Ride 2019 - Entry Form

Rotary Ride 2019 - Entry Form

Creswell Quay, the finish venue!
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Please Copy and Paste the info below onto a word document or e mail Rotarian David Haward

david.haward@rotary.wales.co.uk

Il Giro Di Pembrokeshire

(Rotary Club of Narberth & Whitland Charity Bike Ride)

For

Prostate Cymru & Other Charitable Causes

Sunday 1 September 2019

Entry Form

Please note that by completing this Entry Form, you confirm that you have read and agree to abide by The Guidance Notes and Event Rules.  The information you have given will be used for the safe running of the event.  Each participant should complete their own form.

Rider Details :- Title

First Name

Family Name

House No./Name

Address Line 1

Rider No. (We will assign and advise)

Address Line 2

What distance do you intend to ride?  (You may change the distance when you register on the day).

Address Line 3

Post Town

Post Code

Contact Details :-

Email

Landline 1

Landline 2

(Please carry your mobile on the ride)

Mobile Number

If you belong to a Cycling, Rotary or other  Club, please give the name:-

Club Name

Any Comments

It would help the organisers, if you could advise how you heard of the event.

Heard by

Any Comments

Emergency Contact Details :-

First Name

Family Name

Please state relationship, to rider.

First Contact Number

Second Contact Number

Please make sure you have signed this form. 

Sign Here:-

Please Date:-

If you will be under 18 on 1 September 2019, please state your date of birth

Date of birth:-

For under 18s, please ask your parent/guardian to sign this form too.

Parent/Guardian Sign Here:-

Please Date:-

Park & Ride Scheme.  (Please circle)

Yes Please

No Thank You

The entry fee is based on your age on the ride day.  £5.00 for 12 and under, £10.00 for 13 – 17 and £15.00 for 18 and over.  You can ENTER FOR JUST 50p if you agree to raise a minimum of £10.00 for under 13s, £20.00 for under 18s, £30.00 for adults for the above charities.  Please make sure you have downloaded the Sponsorship Form and bring it with you on the day.

The Cresselly Arms, have kindly offered a superb two course barbecue meal for £9.00 (plus 50p if booked on line).  You are welcome to invite family and friends to join you for meal.  Please make sure you include them in your meal order.

Due to the recent introduction of GDPR we have to give you an option to confirm that we may advise you of next year’s event.  We will not disclose your information to other parties or use it for marketing other events, unless they are connected with or similar to cycling.

Please circle, yes happy to be contacted or no if not.                                  Yes please / No thank you.

Use the box below ONLY if you have NOT booked on line.

Entry Fee Paid:-

Yes

No (Sponsored)

Amount

Meal Required

Yes Please

No Thank You

Amount

Extra Meals Please State Number:-

Yes Please

No Thank You

Amount

Total amount enclosed:-

Total

Please add up the total number of meals required at £9.00 each.  Then add the Entry Fee if applicable. 

If you do not wish to enter online, or do not have a PayPal account.  Complete this form and email to the Event Organiser:-

david.haward@rotary.wales.co.uk

Or post to

Rtn David Haward

Wern Farm

Rhosfach

Clynderwen

SA66 7SJ

Payment may be made by cheque, made payable to “The Rotary Club of Narberth & Whitland”







(ALL fields required)