2018 Credit / Debit Card Autumn Classic Payment Form

Autumn Classic Sportive Registration Form
Please complete all rider details below before clicking PAY NOW.

Thanks Norfolk Cycling Events

My Products *

Autumn Classic Sportive (25,50,75,100 miles) £ 13.50 GBP

Quantity

Autumn Classic 10 miles £ 9.00 GBP

Quantity

Autumn Classic Under 16's Free

Quantity

Break Charity Donation £ 5.00 GBP

Quantity

Total £ 0.00 GBP

Address *

Emergency Contact Name *

First Name Last Name
Emergency Contact Number *
Land Line / Mobile
Agree to NCE Terms & Conditions *

YES = Ride NO = NO Ride Under 16 Rider (Please tick box)

Address

Phone Number

- Area Code Phone Number
Emergency Contact Name

First Name Last Name
Emergency Contact Number
Land Line / Mobile
Agree to NCE Terms & Conditions

YES = Ride NO = NO Ride Under 16 Rider (Please tick box)

Address

Phone Number

- Area Code Phone Number
Emergency Contact Name

First Name Last Name
Emergency Contact Number
Land Line / Mobile
Agree to NCE Terms & Conditions

YES = Ride NO = NO Ride Under 16 Rider (Please tick box)

Address

Phone Number

- Area Code Phone Number
Emergency Contact Name

First Name Last Name
Emergency Contact Number
Land Line / Mobile
Agree to NCE Terms & Conditions

YES = Ride NO = NO Ride Under 16 Rider (Please tick box)

Address

Phone Number

- Area Code Phone Number
Emergency Contact Name

First Name Last Name
Emergency Contact Number
Land Line / Mobile
Agree to NCE Terms & Conditions

YES = Ride NO = NO Ride Under 16 Rider (Please tick box)

Address

Phone Number

- Area Code Phone Number
Emergency Contact Name

First Name Last Name
Emergency Contact Number
Land Line / Mobile
Agree to NCE Terms & Conditions

YES = Ride NO = NO Ride Under 16 Rider (Please tick box)
Should be Empty:

Autumn Classic Sportive Registration Form