1. Name
*
First Name
Last Name
2. Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
3. Email address
*
4. Mobile phone number
*
5. Gender
Male
Female
Other
Prefer not to answer
6. Organisation/Company
7. Date of birth
MM
DD
YYYY
8. Emergency contact name
*
9. Emergency contact number
*
10. Passport Number
*
11. Passport expiry date
*
12. Passport country of issue
*
13. Do you have any dietary requirements/food allergies?
*
Please Select
YES (Please provide details below)
NO
14. Do you have any non-food allergies and/or conditions?
*
Please select
YES (Please provide detail below)
NO
15. Do you have any recurring joint or back problems?
*
Please select
YES (Please provide details below)
NO
16. Do you have any medical conditions (Asthma, Epilepsy, Angina, High Blood Pressure etc)
*
Please select
YES (Please provide details below)
NO
17. Do you have any medial allergies? (Penicillin etc)
*
Please select
YES (Please list details below)
NO
18. Are you taking or require any medication?
*
Please select
YES (Please list details below)
NO
19. Is there anything else you wish to let us know?
*
Please select
YES (Please add detail below)
NO
20. Medical consent
*
23. City Hotel, Beauvais - Night 2
*
Please select the type of room you would like
Single occupancy room (subject to availability and additional charges apply from £109)
Shared room (do not mind who I share with)
Shared room (I would like to share with person listed below)
24. IBIS Hotel, Paris - Night 3
*
Please select the type of room you would like
Single occupancy room (subject to availability and additional charges apply from £179)
Shared room (do not mind who i share with)
Shared room (I would like to share with the person listed below)
None of the above - I'd like to upgrade my hotel (please select upgrade below)
25. I would like to upgrade my hotel in Paris to...
4* Novotel Paris Centre Eiffel Tower SINGLE OCCUPANCY (Subject to availability and additional costs apply from £210)
4* Novotel Paris Centre Eiffel Tower SHARED OCCUPANCY (Subject to availability and additional costs apply from £110)
4* Pullman Paris Tour Eiffel with Eiffel Tower Views SINGLE OCCUPANCY (Subject to availability and additional costs apply from £390)
4* Pullman Paris Tour Eiffel with Eiffel Tower Views SHARED OCCUPANCY (Subject to availability and additional costs apply from £200)
26. I would like to return to London on the following Eurostar?
*
Please select date and time (All subject to availability & additional cost may apply)
Paris to London - 28 April at 13.42pm (Subject to slight timetable change)
Other - Please add date/time below. Additional charges may apply.
27. I would like a bike challenge kit (4 x inner tubes, front & rear lights and a bell)
*
YES - Cost £49. We will be in touch to confirm details.
NO
28. Would you like to rent a bike?
*
Please select
NO
YES - Please contact me to discuss
YES - I have already discussed with TFA Events
29. The make, model and value of the bike you will be riding on the challenge?
31. My contact details
*
32. Insurance agreement (please check all boxes below)
*
33. GDPR Agreement (Privacy policy available below)
*
34. Terms & Conditions (available below)
*
35. I am happy for TFA Events to add me to the challenge WhatsApp group, using the number I entered above on this form. The group is the key way challenge information is shared.
