ENTRY FORM “A” – 100km & 55km Circuit - PLEASE COMPLETE THIS
FORM CLEARLY IN BLOCK CAPITALS- NOTE: ONE CYCLIST PER FORM
NAME: ADDRESS: D.O.B: M/F
_________________________ __________________________ ______________ ______
EMAIL: ____________________________ TEL: ________________________________
SIGNATURE OF PARENT/GUARDIAN: _____________________________________________
Select Route: ___ 100km - (€38 per entry) _____ 55km – (€38 per entry)
Fee Enclosed: €_________(tick one) Cheque____ Postal Order___ Other_______
ENTRY FORM “B” – 14km Circuit (Family Pack) – PLEASE COMPLETE
THIS FORM CLEARLY IN BLOCK CAPITALS- NOTE: ONE FAMILY PER FORM
NAME: ADDRESS: D.O.B: M/F
1__________________________ ________________________ _______________ _______
2__________________________ ________________________ _______________ _______
3__________________________ ________________________ _______________ _______
4__________________________ ________________________ _______________ _______
Parent/Guardian Signature: 1. _________________________________________
Parent/Guardian Signature: 2. _______________________________________
Email: ________________________
Fee (per entry) - Family of 4 (2 adults 2 children) €30 (€15 per extra child)
Fee Enclosed: €_________(tick one) Cheque: ____ Postal Order___ Other_____
** Please note: ENTRY FEES NON-REFUNDABLE >> CASH SHOULD “NOT” BE SENT BY POST
** FORM MUST BE RETURNED TO AISLING GROUP INTL. CHARITY WITH PAYMENT TO BE
REGISTERED **
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