Title:

First name:

Surname:

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Address 2:

Town/City:

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Daytime telephone:

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Chosen route:

Where did you hear about this event?

I understand that this event is not a race and all riders must obey the Highway Code. Cycling can be a dangerous activity and I accept that the North London Hospice cannot be held responsible for personal injury, accident, loss, damage or public liability. Riders under 16 must be accompanied by an adult.

Signed:

Date: