Cycleathon Register Today

REGISTER TODAY FOR THE CYCLE-A-THON!

Once you have registered we will send you your score card to help you record the number of miles you have cycled after each of your cycle sessions. We will also send you a Cycle-A-Thon information pack which includes details of how to take part, fundraising tips and training tips.

SIA Cycle-A-Thon

Title
Firstname *:
Surname *:
Email *:
Reconfirm Email *:
Gender:
Phone *:
Mobile Number:
Address Line 1 *:
Address Line2:
Address3:
Town/City *:
County:
Post Code *:
Would you like to take part as individual or team?	Individual Team
Date of Birth (dd/mm/yyyy) *:
How much sponsorship do you think you can raise?
How did you hear about the Cycle-A-Thon
Which level of miles are you cycling?
	29, 54, 140, 213 or 874 miles?
Where will you be completing the Cycle-A-Thon? *
	If you are taking part at your local gym, which gym will you be taking part at? Or will you be completing the challenge on your own bike outside?
By sending this form you agree to the terms below.
Terms and Conditions *:	I agree to take part in this event at my own risk. To the fullest extent permitted by law, Spinal Injuries Association and its sponsors will not be responsible for any loss, damage, illness, injury or death to person, animal, vehicle or trailer or arising out of my involvement with this event. SIA reserves the right to alter the date or start time of the event at any time for any reason. I am not aware of any medical condition or other reason why I should not participate.



Please help us to beat SPAM and type the words you can see into the box below:
	Send Details