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Pedal For Africa
Please complete the application form to take part in the Leicester to Cardiff / Birmingham to Cardiff cycle ride on the 17th March 2018.

If you pass the entry criteria, you will be requested by the Ride Co-ordinator to go ahead and pay the registration fee of £45 per person, which you purchase on the page you clicked on, to get here (https://www.pennyappeal.org/appeal/pedal-for-africa).

You will also be guided on setting up your Just Giving Donation page so that you can start your fundraising, and to join your Just Giving Page to the Pedal for Africa Team Page

Should you not meet the entry requirements, and you have paid the registration fee, your registration fee will be reimbursed.

Email address *
Gender
Full Name
Your answer
Home Address
Your answer
City
Your answer
Postcode
Your answer
Preferred Contact Number
Your answer
Cycling Jersey Size
How often do cycle a week?
What is the name and model of bike you own? Please also state if it is Road, Hybrid or Mountain.
Your answer
Emergency Contact Name & Relationship (Father, Sister, Mother etc.)
Your answer
Emergency Contact Number
Your answer
Do you suffer from any heart or blood pressure problems?
Have you had a fracture, tendon, ligament or cartilage injury?
Do you suffer from back problems?
Do you suffer from diabetes?
Have you ever suffered from a mental or psychiatric illness?
Are you prone to fainting or epileptic fits?
Do you suffer from migraines?
Do you suffer from allergies?
Are you a smoker?
Do you suffer from Asthma, bronchitis or shortness of breath?
Have you taken part in any long distance sportive events before? If so, please state the name & distance of the events taken part in, including your time, average speed, etc.
Your answer
Ride Start Point
Please provide your strava username & Strava ID (Your Strava ID is a specific number assigned to your account when you register on Strava. It can be found in the address bar when visiting your profile page in a web browser.)
Your answer
A copy of your responses will be emailed to the address you provided.
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