Telephone number (required)
House name/number (required)
Date of birth
Registered as an organ donor?
How do you wish to take part? (required)
Full rider (all stages)Stage riderVirtual rider
Jersey size (required)
Reasons for doing the ride (required)
Cycling experience/miles per day (required)
Medical conditions (required)
Dietary needs (required)
Please provide some information about yourself that we can use on our team profile page and publicity.
Terms & conditions
We advise you take out your own insurance. We do not take responsibility for any loss damage or injuries.
Cycling helmets are mandatory and must be worn at all times.
As a full rider I agree to pay £200 registration fee by February 28 2015 and agree to pledge a further £300 by 31 July 2015.
Stage ridersAs a stage rider I agree to pay £100 registration fee by February 28 2015 and agree to pledge a further £200 by 31 July 2015.
Virtual ridersAs a stage rider I agree to pay £10 registration fee by February 28 2015 and agree to pledge a further £20 by 31 July 2015.
I agree to the terms and conditions above
Every donation counts, big or small. We are grateful for any donation to this wonderful cause.
Make a donation
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