One form for each person, complete in BLOCK CAPITALS PLEASE

Name:

Address:

Postcode:

Telephone:

How did you hear about the bike ride?

I would like to register as a rider in the  50 mile route    /         20 mile route (please circle your preference)

I enclose my entry fee:  £

(full cost £9 in advance £10 on the day; Concessions / under 16s £4 in advance £5 on the day)

Please send me registration details and a sponsorship form.

I would like to join / hear more about the Sheffield Esteli Society which supports health education and building projects in Esteli , Nicaragua and I enclose my subscription of £ 8 full / £ 3 concessions / £15 organisations.

Please send us your completed registration form with your cheque (no cash please), payable to Sheffield Esteli Society, and a stamped self addressed envelope, at least as big as this form! The address is:  Two Peaks Bike Ride,  213 Heavygate Road Sheffield S10 1PH

Please sign here: ............................................................................................................................................

(If under 16 signature of parent or guardian / Under 14s must be accompanied on the ride by an adult)

Disclaimer:  All entrants ride at their own risk,  the Sheffield Esteli Society cannot accept responsibility for personal injury, loss or damage to cycles and equipment loss of personal effects or any public liability , loss or damage to cycles and equipment You are reminded that you are cycling on the public highway and must therefore observe the highway code.

Make sure your bike is safe well before the ride If in doubt get in checked by a good bike shop such as  JE James.