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. Organisation/Company
6. Date of birth
MM
DD
YYYY
7. Emergency contact name
*
8. Emergency contact number
*
9. Passport Number
*
10. Passport expiry date
*
11. Passport country of issue
*
12. Do you have any dietary requirements/food allergies?
*
Please Select
YES (Please provide details below)
NO
13. Do you have any non-food allergies and/or conditions?
*
Please select
YES (Please provide detail below)
NO
14. Do you have any recurring joint or back problems?
*
Please select
YES (Please provide details below)
NO
15. Do you have any medical conditions (Asthma, Epilepsy, Angina, High Blood Pressure etc)
*
Please select
YES (Please provide details below)
NO
16. Do you have any medial allergies? (Penicillin etc)
*
Please select
YES (Please list details below)
NO
17. Are you taking or require any medication?
*
Please select
YES (Please list details below)
NO
18. Is there anything else you wish to let us know?
*
Please select
YES (Please add detail below)
NO
19. Medical consent
*
21. Hotel Calais - Night 1
*
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 (please can I share with the person listed below)
22. Hotel Abbeville - Night 2
*
Please select the type of room you would like
Single occupancy room (subject to availability and additional charges apply from £139)
Shared room (do not mind who i share with)
Shared room (please can I share with the person listed below)
23. City Hotel, Beauvais - Night 3
*
Please select the type of room you would like
Single occupancy room (subject to availability and additional charges apply from £139)
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 4
*
Please select the type of room you would like
Single occupancy room (subject to availability and additional charges apply from £199)
Shared room (do not mind who i share with)
Shared room (I would like to share with the person listed below)
25.I would like to get more infomration on renting or buying the right bike for the challenge?
*
Please select
NO
YES - A member of our team will be in touch
26. 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.
NO
28. My contact details
*
29. Insurance agreement (please check all boxes below)
*
30. GDPR Agreement (Privacy policy available below)
*
31. Terms & Conditions (available below)
*
