Author: Merceraj

Closing date for entries 4th May 2008
In signing this event form, I consent to raising £100 or more in aid of Coronary Care! You will make a difference. THANK YOU!!!
Signed ………………………………………………. Date ………………………………………
ENTRY FORM

‘Coast to Coast Charity Event’ on
5 & 6 July 2008
IN AID OF CORONARY CARE, ROYAL
LANCASTER INFIRMARY

Surname
First Name
Address *1
Address *2
Address *3
Postcode
email
Age
Sex

I declare that I am medically fit to cycle and enter at my own risk. I understand that neither the organisers nor the sponsors are responsible for any injury or illness incurred by me during, or as a result of the challenge/event. Neither are they responsible for any of my personal property lost, stolen or damaged. Participants are responsible for noting any relevant medical information which may prove useful in the event of a medical emergency (e.g. allergies, asthmatics etc) on the reverse of the challenge numbers.