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From: _____________________ Distance: __________________ Date: ___________________________ Fee for Audax UK members: £ _____________________________________________________________ AUDAX UK MEMBERSHIP NUMBER: _____________________________________________________ Fee for other entrants (includes £2 temporary membership): £__________________________________ Date of birth if under 18 years (see parental consent below): ____________________________________ FORENAME: _____________________________ SURNAME:___________________________________ ADDRESS: ____________________________________________________________________________ _____________________________________________________________________________________ Email: ________________________________________________________________________________ Tel: ____________________________________ Mobile: _______________________________________ Club/CTC member group: ________________________________________________________________ INSURANCE: Audax UK provides its members (inc. temporary) normally resident in the UK with 3rd party insurance cover throughout the event for claims in excess of £500. Overseas residents must arrange their own insurance. By signing this form, you declare that you are insured as required. The event is run under Audax UK regulations. You should familiarise yourself with Audax UK regulations, guidance and advice (available at www.aukweb.net or on request from the organiser). The event is not a race or a trial of speed. You are expected to follow the rules of the road and show consideration to other road users. ll You should prepare by studying the route. ll The route is on open public roads. ll You are responsible for your safety and conduct. ll The route is not waymarked or marshalled. ll The organiser provides no rescue service. ll Some routes/conditions may be arduous. PARENTAL CONSENT (required for entrants under 18 years of age): Parents should note the information on this form and be aware that this in an individual ride without ride leaders. I am the parent/guardian of the entrant and give my consent to this entry Signed (parent/guardian): ___________________________________ Date: ________________________ Name (parent/guardian, please print): ______________________________________________________ I understand that during the event I am on a private excursion on the public highway and that I am responsible for my own conduct. I agree to abide by Audax UK regulations for this ride. Entry fees are not refundable. I have relevant insurance cover as above. SIGNED (entrant): _________________________________________ Date: ________________________ Emergency contact (name & tel): __________________________________________________________

From: _____________________ Distance: __________________ Date: ___________________________

Fee for Audax UK members: £ _____________________________________________________________

AUDAX UK MEMBERSHIP NUMBER: _____________________________________________________

Fee for other entrants (includes £2 temporary membership): £__________________________________

Date of birth if under 18 years (see parental consent below): ____________________________________

FORENAME: _____________________________ SURNAME:___________________________________

ADDRESS: ____________________________________________________________________________

_____________________________________________________________________________________

Email: ________________________________________________________________________________

Tel: ____________________________________ Mobile: _______________________________________

Club/CTC member group: ________________________________________________________________

INSURANCE: Audax UK provides its members (inc. temporary) normally resident in the UK with 3rd party insurance cover throughout the event for claims in excess of £500. Overseas residents must arrange their own insurance. By signing this form, you declare that you are insured as required.

The event is run under Audax UK regulations. You should familiarise yourself with Audax UK regulations, guidance and advice (available at www.aukweb.net or on request from the organiser). The event is not a race or a trial of speed. You are expected to follow the rules of the road and show consideration to other road users. ll You should prepare by studying the route. ll The route is on open public roads. ll You are responsible for your safety and conduct. ll The route is not waymarked or marshalled. ll The organiser provides no rescue service. ll Some routes/conditions may be arduous.

PARENTAL CONSENT (required for entrants under 18 years of age): Parents should note the information on this form and be aware that this in an individual ride without ride leaders. I am the parent/guardian of the entrant and give my consent to this entry

Signed (parent/guardian): ___________________________________ Date: ________________________

Name (parent/guardian, please print): ______________________________________________________

I understand that during the event I am on a private excursion on the public highway and that I am responsible for my own conduct. I agree to abide by Audax UK regulations for this ride. Entry fees are not refundable. I have relevant insurance cover as above.

SIGNED (entrant): _________________________________________ Date: ________________________

Emergency contact (name & tel): __________________________________________________________

Send to the organiser: 1. Completed form 2. Cheque payable to organiser (not AUK) 3. Two C5 stamped addressed envelopes.

NAME OF EVENT: ______________________________________________________________________

NAME OF EVENT: ______________________________________________________________________

Send to the organiser: 1. Completed form 2. Cheque payable to organiser (not AUK) 3. Two C5 stamped addressed envelopes.

2016 ENTRY FORM FOR EVENTS HELD UNDER AUK REGULATIONS

2016 ENTRY FORM FOR EVENTS HELD UNDER AUK REGULATIONS

Arrivée 133 - Summer 2016  

Arrivée is the free magazine of Audax United Kingdom, the long distance cyclists’ association, which represents the Randonneurs Mondiaux in...

Arrivée 133 - Summer 2016  

Arrivée is the free magazine of Audax United Kingdom, the long distance cyclists’ association, which represents the Randonneurs Mondiaux in...

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