Macclesfield Bikeathon Sunday 17th May 2009



ADULT 1
Title:
First Name:
Last Name:
House Number or name:
Street:
Address line 2 :
Town or Borough:
County:
Postcode:
Email address:
Telephone Number:
Distance:
T Shirt Size:
Food Choice (please select one from the following)
Ham bap Tuna bap	Cheese bap

ADULT 2
Title:
First Name:
Last Name:
House Number or name:
Street:
Address line 2 :
Town or Borough:
County:
Postcode:
Email address:
Telephone Number:
Distance:
T Shirt Size:
Food Choice (please select one from the following)
Ham bap Tuna bap	Cheese bap

Child 1
First Name:
Last Name:
House Number or Name:
Street:
Address line 2 :
Town or Borough:
County:
Postcode:
Email address:
Telephone Number:
Distance:
Age:
T Shirt Size:
Food Choice (please select one from the following)
Ham bap Tuna bap	Cheese bap

Child 2
First Name:
Last Name:
House Number or name:
Street:
Address line 2 :
Town or Borough:
County:
Postcode:
Email address:
Telephone Number:
Distance:
Age:
T Shirt Size:
Food Choice (please select one from the following)
Ham bap Tuna bap	Cheese bap
Future Contact The organisers of the Macclesfield Bikeathon and the East Cheshire Hospice would like to keep in touch with their supporters. If you would prefer not to be contacted in the future please tick the box.