The Kingspan IHF Genoa to Rome Cycle Challenge 2015 Brochure

The Irish Hospice Foundation

CYCLE E G N E L L A CH h June 2015 27 ay rd tu Sa to Sunday 21 st

n for the Join The Irish Hospice Foundatio along Italy’s challenge of a lifetime by cycling g in Tuscany coast from Genoa to Rome, takin ng the way. and a few optional Giro climbs alo

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N IO T A D N U O F E IC P S O H H IS TH E IR 5 1 0 2 E G N E L L A H C E CYC L se some of This challenge cycle will showca offer. the best sights that Italy has to

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Starting on the coast at Genoa we will pass beautiful seaside resorts, and skirt the UNESCO Cinque Terra as we begin our journey. The trip then moves across Tuscany with its famous landscape and wonderful towns such as Siena, before our big finale arriving at the Basilica of St Peter in Rome.

Cyclists of all levels welcome We welcome cyclists of all levels on our challenge and do this by offering two routes on many days, so that the advanced cyclist can tackle some extra “Giro� climbs while others can continue on with the challenge.

Trip Summary Departing from Dublin on Sunday 21st June, we will fly to Milan and travel to our hotel in Genoa. The following morning we will begin the first of five days cycling through beautiful seaside towns and villages, and will spend our night in Lucca, possibly one of the most wonderful renaissance cities in Italy. It is here that our advanced riders can give the Giro climb at Monte Serra a go!

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Following on from here we will cross more challenging but no less beautiful terrain of Tuscany before we make our way to our final destination on Friday, the magnificent city of ROME! Once there you can look over at the Basilica of St Peter and soak up the roman atmosphere as you contemplate the huge challenge you have just conquered similar to the ancient Roman warriors!

The Challenge You will be cycling a total of 600km over the five days, while raising vital funds for the best care at end-of-life for all. Our Nurses for Night Care programme will be benefiting from the funds raised.

There will be options along the way so that those who are keen and capable cyclists can tackle the climbs Italy has to offer while others can stay on route to continue on the challenge of cycling from Genoa to the historical city of Rome.

A BIT ABOUT CYCLING SAFARIS We enlist the help of the fantastic team at Cycling Safaris to plan our route and manage all aspects of our cycle for the entire duration of the trip.

Cycling Safaris have been organising bike tours in the west coast of Ireland since 1989. Since then they have expanded their cycling holidays to cover the length and breadth of Ireland as well as numerous locations all over Europe. The Irish Hospice Foundation has been working with Cycling Safaris from the beginning of our annual cycling challenges back in 2009. This Italian cycle will be our 10th adventure with them and we are very pleased to have them on the team again.

GENOA TO ROME 2015 This cycle challenge will showcase some of the best sights that Italy has to offer. Beginning at the coast it will pass seaside resorts, and skirt the UNESCO site of Cinque Terra.

The journey then moves across Tuscany with its famous landscape and wonderful towns such as Siena, before our big finale to arrive at the famous St. Peter’s Basilica in Rome. As in previous years the cycle will offer two routes on many days, so that the experienced cyclist can tackle some extra “Giro” climbs and intermediate can continue on the challenge.

ITINERARY DAY 1

SUN JUNE 21

DUBLIN TO MILAN

We will take a fight that morning from Dublin Airport to Milan We will be collected from the airport and transferred to our hotel in Genoa. Genoa has been nicknamed la Superba (“the Proud One”) due to its glorious past and impressive landmarks. Part of the old town of Genoa was inscribed on the World Heritage List (UNESCO) in 2006 and the city is rich in art, music, gastronomy, architecture and history. A beautiful place to begin our Cycle Challenge.

DAY 2

MON JUNE 22

GENOA TO LA SPEZIA 116KM

Our cycle will begin following the coast to Rapallo, with the possibility of a little side excursion to Portofino. We will head inland where the terrain becomes hillier compensated by the views and roads less travelled. A challenging excursion for the advanced riders is a detour to the wonderful UNESCO listed Cinque Terre. Our destination is La Spezia.

DAY 3

TUE JUNE 23

LA SPEZIA TO PISA 120KM

The cycle today will head along the coast passing the miles of ombrelloni and le belle ragazze as we experience the typical Italian seaside resort. We then head inland away from the holidaymakers on some quiet wonderful roads. Before we arrive in Pisa to take the obligatory picture of the leaning tower we will stop by the wonderful city of Lucca, possibly one of the most wonderful renaissance cities in Italy. Its walls are still intact and are a must do extra 4km loop before venturing inside to see the many great buildings including the unique Guinigi tower.

DAY 4

WED JUNE 24

PISA TO SIENA 111KM

As we leave Pisa behind, we find a wonderful optional climb at Monte Serra, although only featured in the Giro twice, it is a legendary ride known as a great training climb for many of the pro-riders. A nice easy cycle crossing fields of sunflowers on quiet roads follows on from here.

A small 1km detour will bring you to the lovely Monterigionni before arriving in Siena. Siena is a city that needs few introductions and the Piazza del Campo is a sight to behold.

DAY 5

THU JUNE 25

SIENA TO BOLSENA 142KM

Day 5 is the most challenging day as we head into countryside dominated by Tuscan hills, medieval villages, cypress trees and vineyards. Leaving Siena behind we pass through Buonconvento a pretty walled town dating from the 14th Century. There follows the charming commune of Abbadia San Salvatore and the backdrop of Monte Amiata. Finally we edge along the Monte Rufeno nature reserve before arriving at the shores of Lake Bolsena, a beautiful crater lake, less well known than many other of the Italian Lakes but no less picturesque.

DAY 6

FRI JUNE 26

BOLSENA TO ROME 126KM

The last day will see us cross the volcanic hills known as Cimini mounts. The wonderful villa Farnese dominates this countryside. The medieval town of Sacrafano awaits, before we make our last ride into the heart of the city. Incredibly for such a hectic city as Rome, there is a quieter route that brings the cycle along the river Tiber almost to the St Peter Basilica and the end of our historic journey – From Genoa To Rome!

DAY 7

SAT JUNE 27

ROME

Everyone returning on the group flight will have an opportunity to take in some of the beautiful sights Rome has to offer before our flight home to Dublin. If there anything in particular you wish to see it is advisable to book online in advance.

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HOW DO I SIG N U P? The total participation fee is €2,990 for the Genoa to Rome, Italian Cycle Challenge.

This fee can only be guaranteed for participants that register and pay their Registration Fee by Friday 13th March 2015. (An additional cost may occur after this date due to the fluctuation of flight &

accommodation costs)

The Total Participation Fee of €2,990 is split into two elements: n Tour Cost of €1,050 n Sponsorship of €1,940 The Tour Cost of €1,050 must be paid as follows: n Registration Fee of €250 on sign-up. n Balance of €800 due 21 days after receipt of Registration Fee Note: Tour Cost of €1,050 can only be guaranteed up to 13th March 2015.

The Sponsorship of €1,940 must be paid as follows: n First payment of €975 due 1st May 2015 n Second payment of €965 due 29th May 2015 DIscOuNteD Rates: Participants can avail of a discount of Sponsorship (€1,940 reduced by €250 to €1,690) by availing of ‘Refer a Friend’ or ‘Team Discount’ in which case each of the Sponsorship payments above are reduced to €845.

Refer a Friend* OFFeR! If you invite a new cycling friend to sign up for the 2015 Cycling Challenge, both you and your friend benefit from a reduced Participation Fee of €2,740 per person. *These offers are only available to participants who introduce a friend who has never participated in the Kingspan IHF Cycling Challenge or Teams of 4 or more (this can include previous participants) who sign-up together.

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INFORMatION WeeKeND An Information Weekend will take place in late spring 2015, and is an opportunity to meet the IHF team and Cycling Safaris as well as other participants. We can answer any queries you may have, give you advice on equipment and training and give you additional information about the trip.

We will also have a modest cycle on this day. This is a really useful day to pick up tips and advice on the route, training and your fundraising.

We strongly encourage you to come to the Information Weekend as it provides an important and valuable opportunity to discuss all matters of the cycle. This is a great chance to get well acquainted with everyone involved in the cycle and an opportunity to gauge your fitness levels!

All presentations from the day will be made available to everyone afterwards. However this does not replace the value of being there in person.

PRe tRIP BRIeFING A detailed pre trip briefing will be sent out to participants approximately one month before departure with all the necessary details including travel arrangements.

team Discount OFFeR!* Sign up as part of a team of 4 or more (this can include previous participants) and receive a discounted Participation Fee of €2,740 per person. Sign up before the 13thMarch 2015 to avail of the discounted rate.

Please note: All team members must have signed as a team at the same time and pay their registration fee of €250 per person.

Find out the difference you can make in one week…

We at the Irish Hospice Foundation (IHF) need your help to ensure that everyone has access to hospice care, when and where they need it. We believe that this is a human right.

However, the reality is quite different. Sadly, access to hospice services in Ireland today largely depends on where you live, and your illness. We are working to change this and we can’t do it without your help.

This June, cycle along Italy’s coast from Genoa to Rome and help us make a difference by raising vital funds for the IHF’s Nurses for Night Care service. The IHF’s Nurses for Night Care is a free service that provides night time nursing care in the home for people with diseases other than cancer who are at the end of their lives. This service enables more people to fulfil their wish to die at home with dignity.

Quite often people die in a setting that is not their first choice.

Our 2014 survey of Irish attitudes to death, dying and bereavement showed that currently 74% of us would choose to die at home, but the truth is that only 26% of us actually do so at present.

We are trying to change this!

The Nurses for Night Care service facilitates, where possible, people’s choice to die at home. The service works across Ireland, reaching every county.

Night time can be a vulnerable time for people who are at the end of life and their families, with fewer services available to them. But our service maintains the continuity of care that this person has experienced during the day, supported by the palliative home care team and surrounded by family.

These nurses stay in the home throughout the night, providing nursing care, practical support and reassurance to both the person with the life limiting disease and their family. The service is a very significant support in providing respite for families, as they in turn care for their loved one at what can be a very difficult time.

The demand for this service is increasing yearly, and in order to fund the service in 2015 we predict that we will need to raise in excess of €500,000! With your help we can continue to increase our fundraising and reach our target for this vital programme.

By signing up for the Genoa to Rome cycle you can help us make a difference. Each day spent in the saddle will mean at least one night of comfort and reassurance for those nearing the end of life and their family. The amount fundraised by each cyclist (after costs) will fund six nights of night time care.

For more information on the work of The Irish Hospice Foundation please visit our website

www.hospicefoundation.ie or speak to a member of staff on 01 6793188.

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QU IC K

FACTS n SECURING YOUR PLACE To secure your place you will need to: • Fill in and return the enclosed registration form by 13th March 2015.

• Pay your €250 non-refundable registration fee. You can do this using the form enclosed.

• No travel arrangements will be made until the full Tour Cost of €1,050 is paid.

Registrations taken after the 13th March 2015 may incur extra costs. This will be made clear to participants in advance of registration.

n SPONSORSHIP TARGETS & DEADLINES Total Participation Fee: €2,990 n Deadline 1: Pay registration fee – €250. n Deadline 2: Pay balance of tour cost – €800, 14 days after receipt of the application form and registration fee to secure your place on the trip.

N.B. No travel arrangements will be made for you until the balance of the tour cost is paid. n Deadline 3: 1st May 2015. You must raise and pay €975 by this date. n Deadline 4: 29th May 2015. By this date you must have raised and paid a further €965, bringing your total Participation Fee €2,990, otherwise you jeopardise your place on the trip.

n FUNDRAISING SUPPORT The team of professional fundraisers at the IHF will provide you with fundraising support including: • Access to fundraising materials and IHF merchandise.

• An online sponsorship account - friends, family and colleagues can sponsor you online through your own personalised web page on www.mycharity.ie or www.idonate.ie • A direct phone number and email address for an IHF fundraiser.

n TRAINING SUPPORT

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This cycle crosses the naturally undulating terrain of Italy. Although not a flat route we will stick mostly to the foothills and not seek out any great climbs. However for the more experienced cyclists and those

If you want to move quickly and guarantee a place, this Quick Facts page contains all of the essential info that you will need to know before signing up.

looking for a greater challenge you can tackle some hillier terrain. It has to be recognised that strong legs and a good cardiovascular fitness are essential - you will be in the saddle for approximately 6 hours a day. We can provide you with the following support to help you train: • Professionally prepared training guide • An information weekend that includes a question and answer session with event staff.

• A list of regular open cycling events to help with your training.

Self motivation is essential!

n SUPPORT TEAM A support team of several staff and vehicles will organise the ride and be responsible for: • Transporting your bike to and from Italy.

• Transferring your luggage from hotel to hotel.

• Mechanical support.

• First Aid support.

• Guiding the route.

• Organising water/snack and lunch stops.

n FOOD & ACCOMMODATION • Accommodation is provided for every night of the trip. It is shared twin rooms in 2H, 3H or 4H hotels. Please indicate anyone that you would like to share a room with on your registration form.

Single rooms are available for an additional fee. If you choose to stay on for the weekend in Italy, you will be responsible for organising your own accommodation and flights.

• Water/snack stops. At least 2 stops (one in the morning and one in the afternoon) will be organised on each day of cycling.

Snack stops will consist of energy bars, fruit, and other snacks suitable for cyclists. However if you have particular snacks you eat whilst cycling we recommend you bring them along for yourself.

• Lunch. Lunch stops are organised to take place in Cafes/pubs, consisting of sandwiches/baguettes. As we are stopping in small villages for only brief lunch stops it is not practical to have a hot meal at the lunch stops. Lunch is not provided on day 7.

• Dinner. On days 1, 2, 3, 4, 5, 6 dinner will be provided to the group either in a local restaurant or in the hotels. On day 7 participants are responsible for buying their own dinner.

• Special dietary requirements. We are only able to accommodate food allergies, specific diets i.e. vegetarian, vegan, and/or religious or medical dietary requirements. Personal preferences cannot be accommodated. Please remember to fill them in on the medical questionnaire that you receive once you have registered. If any individual has particular snack preferences they should consider bringing a quantity with them on the trip.

n TRANSPORT • Flight to Milan on 21th June and return flight from Rome 27th June. For those staying on for extra nights you must make your own return flight arrangements.

n WEATHER Cycling at this time of year is usually pleasant and sunny, but you should come prepared for all weathers. Ensure you have packed a waterproof cycling top and sunscreen.

n BIKE INFORMATION You will need to bring your own bike to Cycling Safaris in Dublin approximately 1 week in advance of the trip for it to be transported to Italy. Please ensure that it has been recently serviced. We will arrange for your bike to be transported safely back to Ireland where it will be available for collection from Cycling Safaris in Dublin.

n WHAT IS NOT INCLUDED? • Travel insurance – mandatory – you must provide us with evidence of your cover. Note: You will not be allowed participate in the trip without Travel insurance.

• Bike insurance • Personal spending money • Lunch and dinner on day 7

TE R MS AN D CON DITIONS The Kingspan IHF Cycle Challenge Genoa to Rome rules and regulations 1. Anyone taking part in this event are acting as volunteers for The Irish Hospice Foundation and are responsible for and obtaining all necessary permits and permissions in respect of public collections.

GENERAL 2. The Irish Hospice Foundation has appointed Irish Cycling Safaris Ltd (The Company) to organise transport, accommodation, first aid and guides for The Irish Hospice Foundation Cycle Challenge (“the Event”) and accepts no liability for any loss or damages howsoever arising or for cancellation of the Event for any reason.

3. The Irish Hospice Foundation has no control over the organisation and running of the Event and all participants take part at their own risk.

4. The Irish Hospice Foundation has no control over what happens on the Event from the time it departs from Dublin to the time of its return to Dublin. The Irish Hospice Foundation is, therefore, under no liability in contract, negligence, or otherwise for any matter occurring during those dates or for any loss or damage sustained by any participant during those dates. Any complaint must be notified directly to the Irish Cycling Safaris Ltd within 14 days of the end of the Event, in accordance with Irish Cycling Safaris Ltd Booking Conditions below.

REGISTRATION FEES AND DONATIONS 5. To secure your place you will need to: Fill in and return the enclosed registration form by 13th March 2015 along with your €250 non-refundable registration fee.

You will need to pay the balance of Tour Cost, €800, 14 days after receipt of the application form and registration fee to secure your place on the trip. N.B. No travel arrangements will be made for you until the balance of the tour cost is paid. Before 1st May 2015 you must have raised and paid €975 of your Sponsorship balance. By 29th May 2015 you must have raised and paid a further €965 bringing your total Participation Fee to €2,990, otherwise you jeopardise your place on the trip.

6. If you are unable to obtain the minimum target amount of sponsorship (€1,940) you are liable to forfeit your place on the Event and your non-refundable registration fee of €250; donations will only be refunded directly to the donor, upon written request by the donor.

7. You must make it clear to all your prospective sponsors that €1,050 of the €2,990 comprises the cost of registration and participation in the Event.

8. Should the Irish Hospice Foundation cancel the Event, the registration fee of €250 will be refundable to you; donations will only be refunded directly to the donor, upon written request by the donor.

9. Should you not be able to take up your place on the Event, donations and registration fees will not be refundable to you; donations will only be refunded directly to the donor, upon written request by the donor.

10. All funds raised in the name of The Irish Hospice Foundation in connection with the Event must be paid as soon as practicable to the Irish Hospice Foundation [in accordance with the method of payment provisions in the attached Application Form].

SAFETY RULES 11. Safety approved cycling helmets are compulsory.

12. You may not deviate from the official route.

13. You are to obey the local traffic regulations, traffic officers and authorised marshals at all times.

14. You may not use your mobile phone or a personal music system while cycling.

IRISH CYCLING SAFARIS LTD BOOKING CONDITIONS 15. Irish Cycling Safaris LTD (The Company) accepts bookings subject to the following conditions: n Passports, Visas Clients are responsible for arranging, and must be in possession of a valid passport and any visa required for the whole of their journey. Information about these matters or related items (climate, clothing, baggage, personal gear etc) is given in good faith but without responsibility on the Company. Clients with a European passport will not need a visa and it is the responsibility of any other passport holders to check with their embassy. n Insurance &Cancellation Insurance Travel insurance is mandatory for all clients whilst on a tour organised by the Company. Clients together with their personal property including baggage are at all times solely at their own risk. Clients are wholly responsible for arranging their own insurance. Clients are responsible for ensuring that they are in possession of private Travel Insurance with protection for the full duration of the tour in respect of at least medical expenses, injury, death, repatriation, cancellation and curtailment, with adequate cover.

Clients should ensure that there are no exclusion clauses limiting protection for the type of activities included in their tour. Clients should satisfy themselves that any travel insurance arranged through the Company is what they require and should arrange supplementary insurance if need be.

Clients will be deemed to have read the insurance cover. n Itinerary While we endeavour to follow our itinerary there may be exceptional circumstances when this is not possible.We reserve the right to cancel or modify the itinerary as necessary. Due to the nature of the trips arrangements have to be planned well in advance, so changes may have to be made and the Company reserves the right to do this. Should a material change be necessary the Company will inform you as soon as reasonably possible. A material change includes, for example, a significant change of destination or route time by more than 12 hours. n Medical Form Prior to the event you will be asked to complete a medical questionnaire. If you are over 60 years of age or if you have any medical condition that could be adversely affected by exercise, particularly a heart condition or asthma, you must provide the Company with a medical certificate from your doctor. By signing this form you are confirming that, to the best of your knowledge, your general state of health is good and that you take full responsibility for your health and personal well being. All medical forms will be independently reviewed by a doctor prior to departure. n Minimum Age Participants must be over the age of 18 on the day of departure. The Company reserves the right to refuse participation to anyone at any time without having to disclose the reason. n Challenge Participation We accept your booking on the understanding that you realise the hazards involved in this type of tour, including injury or death, disease, loss or damage to property, and that you come on the tour at your own risk.We accept no liability for any injury resulting from the hazards of cycling or any other activity included in the itinerary, or for any other mishaps to

yourself or your property, and in particular as a consequence of strikes, wars, riots, sickness or other such happenings. Any independent travel arrangements that you make are also at your own risk. While on the cycle, illegal behaviour or conduct considered unsuitable will not be tolerated and could result in the participant being asked to leave the cycle with no refund. The decision to participate in the cycle or parts therein lies with each individual. n Equipment Clients taking their own equipment on tour are responsible for any charges for transportation levied by the transport provider including excess baggage.

You must wear a helmet on this trip. Clients are responsible for ensuring that their bike is in a suitable condition for participation in a cycle of this nature.

The company will endeavour to accommodate clients, but cannot guarantee that correct tools and spares will be available. Clients will be expected to pay for any spares they require during the trip. n If you have a complaint Should you have a complaint about any of the tour arrangements, you must tell both the relevant supplier and the Company’s representative whilst on the trip or within 14 days of the end of the Event. It is only if the Company and the relevant supplier know about problems that there will be the opportunity to put things right. n Delays The timings of road, ferry or flight departures are estimates only. We cannot accept liability for any delay in your travel arrangements from or to Ireland whether the cancellation or delay is caused by adverse weather conditions, rescheduling by a transport provider, port authority, mechanical breakdown or industrial action. Where long delays result in lost challenge time, no refunds are given by hotels or suppliers. Similarly, transport providers do not offer compensation for delays. It is in recognition of the above that the Company’s travel insurance policy offers some monetary compensation for delays over 12 hours to cover lost time or delayed return.

This Event is conceived and operated by Irish Cycling Safaris Ltd. [Ground arrangements are fully insured through IrishCycling Safaris Ltd.] Irish Cycling Safaris Ltd, Belfield Bike Shop,UCD Belfield, D-4 WAIVER 16. Participants hereby acknowledge that they take part in the Event and all functions and events related thereto at their own risk. Participants hereby agree for themselves, their executors, administrators, heirs, next-of-kin, successors and assigns to waive release and discharge and to neither have nor institute any claims whatsoever against The Irish Hospice Foundation or Irish Cycling Safaris Limited.

This waiver covers death, disability, personal injury, damage to and loss of property of a participant and is effective whether or not such death, injury, damage or loss may have been caused directly or indirectly or wholly or partly by any act or omission including negligence, of The Irish Hospice Foundation or Irish Cycling Safaris Limited or their respective servants, agents and contractors and will bind the heirs, executors and/or trustees of the estate of a participant.

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IHF

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E L C Y C C HA LLE NGE

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Registration

FORM to ROM E

SUN 21 - SAT 27 JUNE 2015

Are you a smoker?

PERSONAL DETAILS

Yes

IHF Official Cycle Challenge 2015 Cycling Jersey.

Title

________________________________________________

Name(s)

________________________________________________

Surname

________________________________________________

Address

________________________________________________

JERSEY SIZE CHART

________________________________________________

S HEIGHT cm 172 – 176 CHEST cm 92 -96

Please see size chart and tick size req.

Cycle Jersey Size

________________________________________________

No

S

M

L

XL

M L 175 – 179 178 -182 96 – 100 100 -104

XXL

XL 181 – 185 104 -108

3XL

4XL

XXL 3XL 184 – 188 187 -191 108 -112 112 – 116

4XL 190 – 193 116 -120

Sex (M/F)

________________________________________________

Phone (day)

________________________________________________

Phone (mob)

________________________________________________

Fax

________________________________________________

Email address

________________________________________________

Will you be returning with the group on Saturday 27th June?

Yes No If you are not returning with the group you must inform IHF before the 13th March 2015 otherwise it will be assumed that you will NOT be returning with the group and no return flight will be booked or an additional cost may incur after this date. If travelling separately from the group you are responsible for booking your own accommodation for the extra nights and your return flight home. We will be happy to provide you with the name and details of the hotel in Italy.

Title

________________________________________________

I have read and agree to abide by the Rules and Regulations in the accompanying event brochure which I understand may change from time to time and be posted on the web site www.hospicefoundation.ie. In particular, I have read and agree to the terms of the Waiver at clause 16.

Name(s)

________________________________________________

Signed: ______________________________________ Date: _____________

Surname

________________________________________________

Address

________________________________________________

Date of Birth (must be over 18) __________________________________

NEXT OF KIN

PLEASE NOTE: All accommodation will be shared Do you have a preference for who you wish to share with?

________________________________________________

Yes

No Please specify name__________________________________

________________________________________________

If you do not wish to share there will be an additional single supplement charge,

Relationship

________________________________________________

are you happy to pay this?

Phone (day)

________________________________________________

Phone (mob)

________________________________________________

PASSPORT DETAILS NB: Passport must be valid for 6 months after date of travel

Name (as on passport) _________________________________________

Yes

No

PAYMENT DETAILS I enclose a cheque for the amount of €250 made payable to the Irish Hospice Foundation Please charge €250 to my (Tick as appropriate) VISA MASTERCARD LASER Credit Card Number

Passport Number

_________________________________________

________________________________________________________________

Expiry Date

_________________________________________

Place of Issue

_________________________________________

Exp Date CVV No ________________________________________________________________

Date of Issue

_________________________________________

Nationality

_________________________________________

Country of Residence _________________________________________ Do you have any special dietary requirements?

Yes No If yes, please give details. Please note we can only cater for allergies not preferences ________________________________________________________________ ________________________________________________________________ During the fundraising time before the cycle your fellow cyclists may wish to contact you. If you agree to have your email shared with the other cyclists ONLY please tick the following box

Name on Card ________________________________________________________________ Address Of Cardholder ________________________________________________________________ ________________________________________________________________ Participation in the cycle is at the sole discretion of The Irish Hospice Foundation Please return your completed application form plus deposit to: Amy Vaughan, Irish Hospice Foundation, 32 Nassau St, Dublin 2, Ireland Amy is contactable at 01 679 3188 or amy.vaughan@hospicefoundation.ie

www.hospicefoundation.ie All information on The Irish Hospice Foundation Cycle Challenge 2015 is correct at time of going to press.

CHY: 6830