Registration Form

 
Your Details
 
   Surname:  
 
Date of Birth:  
 
Gender:
 
Email:    
 
Phone No:  
 
Address:  
 
Emergency / Medical Information 
Emergency Contact Name:   Phone No:  
 
Cycling Ireland Information
Cycling Club:
Do you hold a Cycling Ireland number? If Yes, enter CI number here:

Additional Sponsorship
 
Rules and Regulations
 
*By entering this event, I confirm that I will behave responsibly and ride with due care and attetion to other riders, spectators and members of the public who happen to be in the vicinity. my bicycle is in good working order and I will wear a suitable cycle helmet at all times.
*I further understand taht the event organisers do not provide and personal insurance for riders, and that any third party damage I cause will be charged against me.
*I fully accept and agree that neither the organisers, officails, marshals or fellow participants, nor any person associated with the event may be held liable for any loss, damage or injury to me or my party that may occur during or in connection with the event.
*There will be no refund unless the event is cancelled by the organisers and then any refund will be subject to expenses incurred.


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