Title
*
Mr
Mrs
Miss
Ms
Dr
Name
*
First Name
Last Name
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Email address
*
Mobile phone number
*
Date of birth
MM
DD
YYYY
Emergency contact name
*
Emergency contact number
*
Passport Number
*
Passport expiry date
*
Passport country of issue
*
Do you have any dietary requirements/food allergies?
*
Do you have any allergies, including non-food allergies?
*
Please select
YES (Please provide detail below)
NO
Do you have any recurring joint or back problems?
*
Please select
YES (Please provide details below)
NO
Do you have any medical conditions (Asthma, Epilepsy, Angina, High Blood Pressure etc)
*
Please select
YES (Please provide details below)
NO
Do you have any medial allergies? (Penicillin etc)
*
Please select
YES (Please list details below)
NO
Are you taking or require any medication?
*
Please select
YES (Please list details below)
NO
Is there anything else you wish to let us know?
*
Please select
YES (Please add detail below)
NO
Medical consent
*
Would you like to rent a bike?
*
Please select
NO
YES - A member of our team will be in touch
The make, model and value of the bike you will be riding on the challenge?
*
My contact details
*
Insurance agreement (please check all boxes below)
*
GDPR Agreement (Privacy Policy available below)
*
Terms & Conditions (available below)
*
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 a key way challenge information is shared
*
