Flintshire Cycle Challenge

Entry Form

Please accept my entry for the Sir y Fflint ride on Sunday 7th October 2007 (please tick the applicable event and include entry fee).

Seniors

Sir y Fflint Mawr £9.00		After 7th September £12.00
Sir y Fflint Bach £9.00		After 7th September £12.00
Bala Circuit £9.00		After 7th September £12.00
Mold - Mills £6.50		After 7th September £8.50

Under-18

Sir y Fflint Mawr £6.00		After 7th September £8.00
Sir y Fflint Bach £6.00		After 7th September £8.00
Bala Circuit £6.00		After 7th September £8.00
Mold - Mills £5.00		After 7th September £8.00

 

Cheques payable to B.N.E.C.C.

I agree to participate in this even entirely at my own risk and understanding that no liability shall attach to the Organiser, the Birkenhead North End Cycling Club - The Bike Factory, Flintshire County Council or any officers of the event, for any injury, loss or damage suffered by me in or by any reason of the event, however such may be caused and whether by negligence or otherwise.

Signed _____________________________ Date __________

Full Name _________________________________________

Cycling Club _______________________________________

Address ___________________________________________
__________________________________________________

Parental or Guardian consent for entrants under 18

Parent/Guardian _____________________________________

Address (if different from above) ________________________
_________________________________________________

Signed _____________________________ Date __________

Completed entry forms should be sent to:
Graham Smith
Library H.Q.
County Hall
Mold
Flintshire
CH7 6NW

Promoted by Flintshire Leisure Services and Birkenhead North End CC (The Bike Factory)