Great British Bike Ride 2012 - Registration

Supporting CHICKS Charity

CHICKS is a children’s charity that aims to provide life enhancing respite breaks to as many disadvantaged children as possible at one of our retreats in Devon or Cornwall.

The children CHICKS support come from a variety of backgrounds – those living in poverty, children that are being neglected or abused, either mentally, physically or sexually, children who have lost parents or even children who are full time young carers.

CHICKS has two retreats, one based in Brentor, near Tavistock, Devon and the other based in Tywardreath, near Par in Cornwall. Both retreats take a maximum of 16 children at one time; 8 boys and 8 girls, within an 8-11 or 12-15 age range, which ensures a friendly and supportive “family” atmosphere. The children take part in a host of fun activities, leaving with lots of wonderful memories and new friends.

If you would like to register online for the Great British Bike Ride and support and raise money for CHICKS Charity, please complete the form below and we will process your registration.

The Great British Bike Ride Entry Form is secured using a 128-bit encrypted connection, meaning your details are always safely stored and processed. Please click the logo on the left to verify the secured connection.

01. Basic Information
Five Day Rider: £1500.00 As there are only a limited amount of entry's available on the GBBR 2012 your entry registration does not guarantee your entry. You will be contacted by a representative from your selected charity who will confirm your entry application has been successful and a £250.00 fee is paid, which is part of your £1500.00 pledge. Please tick the box to the right to confirm that you would like to take part in GBBR 2012 and support CHICKS Charity. In doing so, you agree to pledge £1500 for your participation.

01. Basic Information

Five Day Rider: £1500.00

As there are only a limited amount of entry's available on the GBBR 2012 your entry registration does not guarantee your entry. You will be contacted by a representative from your selected charity who will confirm your entry application has been successful and a £250.00 fee is paid, which is part of your £1500.00 pledge.

Please tick the box to the right to confirm that you would like to take part in GBBR 2012 and support CHICKS Charity. In doing so, you agree to pledge £1500 for your participation.

If you are taking part in the event as part of a Relay Team, please tick the box:

02. Personal Details
Team Name (If applicable)
Your Name *
Address *
Postcode *
Daytime Phone *
Evening Phone
Mobile *
Email Address *
Twitter Address

03. Additional Details
Where did you hear of the event?
What made you decide to take part in the Great British Bike Ride 2012? *
Would you please give details of a person to whom we can contact in the event of an emergency:
Emergency Contact name *
Emergency Contact telephone *

Great British Bike Ride with CHICKS Charity can offer the following optional extras:
Five Day Stage Rider Options You will not be charged for your optional extras through your selected charity. You will be contacted by a member of the GBBR admin team on your confirmation that your entry application has been successful.
Camp Bed (5 Night Hire) - £15.00
Extra Match Day Tickets:
Extra Match Day Tickets - £20.00 each Great British Bike Riders are entitled to one match day ticket each which will be sent in your rider information pack. We have had several calls from riders enquiring about extra tickets for family and friends. These are available at a cost of £20.00 each and can be purchased through our online registration service. At the moment we have a block of four hundred seats that we have purchased through the RFU and we are all seated together. These tickets are at a special price and will not be available for long.
Transport Options - the Great British Bike Ride can offer the following transport options:
Bicycle Transport to Land's End - £29.00 Riders using this service will be able to drop their bikes off at Twickenham Stadium on Sunday August 26th, between 7am and 9am. They will then be transported to Land’s End by truck. Please make sure your bikes are fully insured for the journey. Your bikes will be stored safely until your arrival on Monday, August 27th at Sea View Holiday Park, Lands End.
Executive Coach to Land's End - £35.00 The executive coach will take you from Twickenham Stadium to Land’s End on Monday, August 27th, departing at 0700hrs. The Executive coach will drop you directly at the See View Holiday Park which is our campsite for the first night and is only a quarter of a mile from Land's End. The journey time is anticipated to be five hours. The coach will be air conditioned with also toilet and the chance to purchase cold drinks, tea and coffee etc on board.

Event Rider Shirts
	1 event rider shirt valued at £45 is included in your entry fee. Please indicate your sizes below. We have had several calls from riders enquiring about extra event shirts. These are available at a cost of £45.00 each, please update the quantity to more than 1 if you would like to order additional shirts.
Men's Sizes		Women's Sizes
XS		8
S		10
M		12
L		14
XL		16
XXL

04. Entry Confirmation
Please tick to confirm that the information given above is true and you have read the events 'Rules and Regulations'.
Please tick to confirm that you will pledge £1500.00 to CHICKS Charity and pay £0.00 for the additional Optional Extras.

* Items marked with an asterix are required.