L A M PORT HAL L September
2
September 18-19 For registraon and sponsorship forms log on to: Or call the Hospice fundraising office on 01604 973340 or email [email protected] Supporng Cynthia Spencer Hospice Cynthia Spencer Hospice Charity No: 1174402 Company No: 10934348 Cycle4Cynthia #cycle4cynthia CynthiaSpencerTV Cycle4Cynthia Cycle4Cynthia Sponsored by MILE ROUTE 25 VIRTUAL CHOOSE YOUR DISTANCE 18-19th SEPTEMBER 19th SEPTEMBER From 7.30am LAMPORT HALL Northampton MILE ROUTE 50 BOOK EARLY AND PAY LESS! RIDE FROM LAMPORT ADULTS £15 CHILDREN £7.50 ADULTS £20 CHILDREN £10 from 19th July VIRTUAL ADULTS £10 CHILDREN £5 FAMILIES £25 ADULTS £15 CHILDREN £7.50 FAMILIES £35 from 19th July
Transcript of L A M PORT HAL L September
September18-19
For registration and sponsorship forms log on to:
Or call the Hospice fundraising office on
01604 973340or email [email protected]
Supporting Cynthia Spencer Hospice
Cynthia Spencer Hospice Charity No: 1174402Company No: 10934348 Cycle4Cynthia #cycle4cynthiaCynthiaSpencerTVCycle4Cynthia Cycle4Cynthia
Sponsored by
LAMPORT
HALL
MILEROUTE
25 VIRTUAL CHOOSE YOUR
DISTANCE
18-19th SEPTEMBER19th SEPTEMBERFrom
7.30amLAMPORT
HALLNorthampton
MILEROUTE
50
BOOK EARLY AND PAY LESS!
RIDE FROM LAMPORTADULTS £15
CHILDREN £7.50
ADULTS £20 CHILDREN £10
from 19th July
VIRTUALADULTS £10
CHILDREN £5FAMILIES £25
ADULTS £15 CHILDREN £7.50
FAMILIES £35
from 19th July
Supporting Cynthia Spencer HospiceCharity No: 1174402 Company No: 10934348
ENTRY FORM
1
I wish to enter the Cycle4Cynthia charity cycle rideover the weekend of 18th - 19th September 2021
DISCLAIMER
Your details (please use BLOCK CAPITALS)
Name Date of birth
Address Post code
Male/Female (delete as appropriate) Mobile
Email address
Cynthia Spencer Hospice, who administer this event, will not share your details with any other organisations. We would however, like to keep in touch occasionally with news of our work and fundraising activities, including Cycle4Cynthia, using the contact details you have supplied. If you prefer not to be contacted this way please tick hereEntries close 3rd September
On entering the event, I understand that the organisers cannot be held responsible for any injury or loss sustained by me however caused and arising from my participation in Cycle4Cynthia. I agree to abide by the Highway Code, the Countryside Code and the Event rules.
Signed Date
If you are under 16 we need your parent or guardian to sign below to agree to the conditions of entry on your behalf. An adult must accompany all children under 16.
Print Name Signed Date
Please make cheques/postal orders payable to ‘Cycle for Cynthia’ and post to: C4C, Fundraising Office, Cynthia Spencer Hospice Charity, Pondwood House, Pondwood Close, Moulton Park, Northampton, NN3 6RT. Unfortunately we are unable to offer refunds for cancellations.
I opt in for email contact byCynthia Spencer Hospice
I opt in for telephone/SMS contact byCynthia Spencer Hospice
MILEROUTE
50MILE
ROUTE
25 VIRTUALCHOOSE YOUR
DISTANCE
September18-19
Call the fundraising office on 01604 973340 with any queries
#cycle4cynthia
LAMPORT
HALL
PAYMENT
RIDE FROM LAMPORTAdult £15.00Child (12 & under) £7.50
From 19th July 2021Adult £20.00 Child £10.00
VIRTUALAdult £10.00Child (12 & under) £5.00Family (2 Adults 2 Children) £25.00
From 19th July 2021Adult £15.00 Child £7.50 Family £35.00
Adult
Child Family (*see note below)
Donation
Total
If you wish to pay your entry by credit or debit card please complete this section.
Credit Card Number
Expiry Date Security No Issue No Start date
* If you are entering a family please include all names and addresses on this form and continue overleaf.
Please
£
£
£
£
£
Enter amount
Please add your telephone number here in case we need to contact you when processing your payment
Sponsored by
19 SEPT 19 SEPT 18-19 SEPT
