ENTRY FORM FOR ROAD & CIRCUIT RACES UNDER

THE TECHNICAL REGULATIONS OF BRITISH CYCLING

To the Organiser: (PLEASE USE BLOCK CAPITALS)

Event name:

Date of race:

Category of race:

Title: (Mr/Miss/Mrs)

Date of birth:

I enclose entry fee of:

£

First Name:

Surname:

Address:

Town:

County:

Postcode:

Home Telephone:

My E-mail address:

Date entered:

BC Licence No:

UCI code:

Category:

Club/Team:

Registered Colours:

I am not prepared to be nominated as a reserve:

Key sponsors:

Licence points gained: (if applicable)

Premier calendar points gained: (if applicable)

Last season:

This season

Last season:

This season:

Best performances in British Cycling or UCI sanctioned events this year and last year:

Placing

Name of Event:

Date:

Distance:

Category:

Name of Winner:

1

2

3

4

5

6

DECLARATION- I declare that I am eligible under British Cycling Technical Regulations to enter this race and that the information on this form is complete and correct. I understand and agree that I participate in this race entirely at my own risk, that I must rely on my own ability in dealing with all hazards and that I must ride in a manner which is safe for myself and all others. I am aware that when riding in an event and particularly when riding on a public highway the function of the marshals is only to indicate direction and that I must decide if the movement is safe. I agree that no liability whatsoever shall be attached to the promoter, promoting club, meeting sponsor(s), British Cycling, or any official or member of the British Cycling or member of the promoting club in respect of any injury, loss or damage suffered by me in or by reason of the race, however caused.

Signed

ENTRIES WITHOUT CORRECT FEE OR DETAILS WILL NOT BE ACCEPTED

Entry forms are available from Membership & Event Services, British Cycling, National Cycling Centre, Stuart Street, Manchester M11 4DQ Tel: 0870 871 2000. Fax 0870 871 2001 Copyright BCF 2004