You are here - Events - Bill Bradley - Entry Form

To enter by post click here and
then print off the entry form

On Line Entry for

This form allows you to enter the event with secure on-line payment.

Go back to the Bill Bradley Page

The entry fee is a minimum of £8.00 per rider.
ALL monies raised go to MacMillan Nurses charity

Complete the entry form and submit the details.

To enter more than one rider and make one payment, use the "back" function to re-load the entry form and then enter the names of all riders.

Pay the required amount i.e for 3 riders a minimum of £24.

Enter the names of all the riders again during the payment process

On line payment made by

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Complete your entry and view a list of entered names

Title	First Name A value is required.	Surname A value is required.Minimum number of characters not met.Exceeded maximum number of characters.	Note that you must be over 16 years old to enter on line. Entries for 12 to 16 years old must be by printed form.
Address	A value is required.Minimum number of characters not met.Exceeded maximum number of characters.		Format for date must be YYYY-MM-DD
Post Code	A value is required.Exceeded maximum number of characters.	Telephone A value is required.	Date of Birth A value is required.Invalid format.
e-mail	A value is required.Invalid format.	confirm e-mail A value is required.The values don't match.
Next of Kin	A value is required.	Telephone A value is required.
Name of Cycling Club (if any)			Preferred Route
Please read the following and Agree/ Disagree I wish to take part in the Bill Bradley memorial Ride and I understand that Southport CC will not be responsible for any personal injuries sustained while undertaking this bike ride. I understand that this event is not a race and I must obey the Highway Code. Please select a valid item.Please select an item.
	Submit Entry Form		Reset Entry Form

Southport CC will retain your personal information from the event entry form for administration of the event.

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