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
*
Company / Organisation name
*
Please select
Blackstone
Bedell Cristin
Deloitte
Indurent
Mourant
Revantage North America
Revantage Luxembourg
St. Modwen
Other (Please list below)
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
*
Accommodation night one - DFDS ferry cabin
*
Select an option
Shared 4-berth room (do not mind who I share with)
Shared 4-berth room (please can I share with the person listed below)
I'd like to be in a cabin for two people (subject to availability, additional charge of £129 per person)
Single occupancy room (subject to availability and additional costs apply from £209)
Accommodation night two - City Originals Hotel Beauvais
*
Select an option
Single occupancy room (subject to availability and additional charges apply from £139)
Shared twin room (do not mind who I share with)
Shared twin room (I would like to share with person listed below)
Accommodation night three - Ibis Cambronne, Paris
*
Select an option
Single occupancy room (subject to availability and additional charges apply from £189)
Shared twin room (do not mind who i share with)
Shared twin room (I would like to share with the person listed below)
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 - 18 May at 09:02 am (Subject to slight timetable changes)
SOLD OUT - Paris to London - 18 May at 10.01 am (Subject to slight timetable changes)
SOLD OUT - Paris to London - 18 May at 13.32 pm (Subject to slight timetable changes)
No return travel needed
Other date/time required (please provide details below, tickets at other dates/times will incur additional charges)
My cycling shirt size is
*
Size guide to right of size (W-Women's dress size / M-Mens chest size). Size up for a looser fit or down for a tighter fit. Guide is available below.
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 agreement
*
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
*
