Macmillan Dorset Bike Ride

Please fill out this form, print out and post to the address at the bottom of the page along with your entry fee (Ł5.00) . Only one name per entry form, strictly no C/O address.

Team Name (if applicable)
Team Leader (if applicable)
Title	Mr Mrs Ms Miss
First Name
Surname
Address



Postcode
Telephone
E-Mail Address
Company/Place of work

I agree to abide by the Terms and Conditions

Signature...........................................................

PARENTS CONSENT IF UNDER 16: Signature.................................................... Age

between	08:00 09:00	08:30 09:30	09:00 10:00	10:00 10:30
100 miles
60 miles
50 miles
40 miles
25 miles
15 miles

I enclose my Entry Fee of Ł 5.00

Please note: the entry fee of £5 does not cover the cost of this event. We rely on your fund raising endeavours and welcome donations to Macmillan Cancer Support at this stage.

I enlose £5 for my Macmillan Dorset Bike Ride T-Shirt, S, M, L, XL (Please state size)
I enlose £25 for my Macmillan Dorset Bike Ride Cycling Jersey. S, M, L, XL (Please state size)
I will collect on the day Please mail to me

Please include £ 1 for postage and packing per order.

I last rode in the Macmillan Dorset Bike Ride in ......................(year)
If you have not taken part before please tell us where you heard about the ride.

Closing dates for entries - 23rd June 2008. Only officially registered riders will be allowed to ride on the day.

Please do not send cash. Please make cheques/postal orders payable to 'Macmillan Cancer Support'

Data Protection Act 1998 - Macmillan Cancer Support Dorset Bike Ride would like to hold your details in order to keep you informed of the event. If you do not want us to use your details in this way please let us know or simply do not supply your email address.

POST TO :
Macmillan Cancer Support, Dorset Bike Ride, PO BOX 1432, Broadstone, Dorset BH18 9YE