Macclesfield Bikeathon Sunday 17th May 2009



Title:
First Name:
Last Name:
House Number or Name:
Street:
Address line 2 :
Town or Borough:
County:
Postcode:
Email address:
Telephone Number:
Distance:
Age (if under 16):
T Shirt Size:
Food Choice (please select one from the following)
Ham bap Tuna bap	Cheese bap
To be completed by Parent/Guardian of any unaccompanied rider under 16 I agree that my son / daughter may take part in the Macclesfield Bikeathon on 17th May 2009
Signature (please type your name):
Date:
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.