In aid of the Woking and Sam Beare Hospices

Pedal4Charity 2009: Bike Ride, Village Festival, The Cricketers, Horsell, Woking Surrey

Sunday 12th September 2010 at 11am:
18 mile round-trip from The Cricketers, Horsell Birch
- via The Rose & Crown, Thorpe Green

REGISTRATION NOW OPEN

Please complete the following form to register for the Pedal4Charity Fun Bike Ride:

REGISTRATION FEE: £10.00

(all proceeds will be used to stage this fundraising event, with any remainder donated to Woking and Sam Beare Hospices)

Personal Details

Date of Birth*

NB. applicants must be at least 16 years old on 13th September 2010. Under 16s must be accompanied by an adult. YOU WILL BE ABLE TO ADD UNDER 16s TO YOUR REGISTRATION ON THE NEXT PAGE

Email Address
Title* First Name*
Surname*
Address*
Postcode*
Telephone*
Mobile

Emergency Contact

Emergency Contact name on event day*
EmeRgency Contact Telephone*

T-Shirt

Which Size T-Shirt Do You Require?*

Small
Medium
Large
X-Large

Your Health

It is important that Pedal4Charity are aware of any health problems that you or any of the children in your care suffer from that might require medical attention during the ride.

Do you or any of the Under 16’s in your care suffer from any such health problems?*

If yes, please state, including any prescribed medication

Other Info

Did you take part last year?

Where did you hear about Pedal4Charity?
Why have you chosen to take part?

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Barn Dance 2010

Scrumptious Supper & Wine, and Dance in The Big Tent on the Village Green
Charity Auction
Click here for more details

All proceeds go Woking and Sam Beare Hospices

based in Woking & Weybridge and covering a wide area of Surrey.

Woking & Sam Beare Hospices provide a palliative care service to the community including In-patient Units, Day Care Units, Community Macmillan Nurses, Counselling Team, Chaplaincy Team, Physiotherapists and Occupational Therapists.

All the services are free and this year WSB Hospices annual running costs are £4.5million.

They need this amount to continue to provide the ongoing specialist care and support for patients and their families

01483 762378