Flying by the seat of our…. Bikes- Entry Form 30 mile cycle ride - Tuesday 24th September 2013 Title:
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Postcode: Tel no (day):
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I confirm that I am 18 years of age or over (please tick) ENTRY FEE £35 entry fee enclosed (please tick) I agree to raise a minimum of £300 sponsorship (please tick) If you would prefer to pay your £300 sponsorship monies yourself please tick here I’d like to pay my sponsorship of £300 by credit/debit card (tick box) Please debit £335 from my debit/credit card (including my £35 entry fee) I will be raising sponsorship via Just Giving (tick box) My Just Giving website address is ___________________________ PAYMENT DETAILS Please make cheques payable to Devon Air Ambulance Trust I’d like to pay my entry fee of £35 by credit/debit card (tick box) Visa
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(please complete details below) Issue No (if applicable) Start date:
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Security code (last digits on the back of card): Disclaimer: All participants should satisfy themselves that they are fit to take part before entering. If you have any doubts , please refer to your GP. The organisers reserve the right to prohibit individuals from taking part . We strongly advise participants to wear helmets and other suitable protection, ie. Knee pads, gloves, etc. The minimum age participants is 18 years. Participants must not be under the influence of alcohol. If participants are taking medication which could cause drowsiness, etc. Please seek medical advice before completing the entry form. Participants should follow the Highway Code at all times see www.highwaycode.gov.uk. Please take extra care if the weather is wet and remember pedestrians have right of way on towpaths. Participants must not use personal stereos whilst cycling. Racing or proceeding at speed is prohibited. Any rider found doing so will be eliminated from this ride and excluded from any future rides. Please show respect to pedestrians on paths. Cancellation Policy: If the event is unable to take place due to unforeseen circumstances, the organiser will be entitled to cancel the event. In such circumstances, we will try to let you know in writing of the cancellation. In the event of cancellation your entry fee and sponsorship received via any online giving site is non refundable and the event organiser will accept no other liability to you for any costs or expenses you may incur as a result of that cancellation. Participants permit Devon Air Ambulance Trust to use any photographs taken during the ride for any advertising or editorial purposes, including the internet. Devon Air Ambulance Trust reserves the right to change the route or event venues if required.
If you have any queries with your entry form please contact Devon Air Ambulance Trust on 01392 466666
I confirm that I have read and understood the disclaimer notice Signed _________________________________
Supporting
Devon Air Ambulance Trust
Date ______________________
01392 466666 www.daat.org Registered Charity No: 1077998 Company No: 3855746
Please return your completed entry form, entry fee and sponsorship monies to Devon Air Ambulance Trust, Unit 5 Sandpiper Court, Harrington Lane, Exeter, EX4 8NS