Golden Bond Application Form: Prudential RideLondon 100 (2ndAugust 2015)
Join the Eikon Team at the Prudential RideLondon-Surrey 100 cycle event on the 2nd August 2015and help support vulnerable young people in Surrey.
The Eikon Charity is delighted to say that we have been granted a very limited number of Golden Bond (or “guaranteed”) places for the 2015 RideLondon 100 event. This is set to be cycling equivalent of the London Marathon (organised by the same team), and was been created as a legacy of the Olympic 2012 cycling extravaganza! Last year’s event was a huge success.
We ask that all cyclists taking one of these places pledges’ to raise a minimum of £500 for The Eikon Charity, as well as paying a £50 entry fee. All the money you raise will help us work towards our vision of developing happy, thriving and resilient young people, who are able to positively contribute to society.
If you feel that you are able to raise this amount and would like to be considered for a place, please complete this form and email it to
Please fill out every question below. Allocation of places will depend entirely on the information given on this form so please provide as much as you can.
Personal Details:
Title: / First Name: / Surname:Address:
Post Code:
Occupation:
Date of Birth (required by RideLondon):
Contact phone number:
Email:
Job Title/Position:
Employer:
Does your employer operate a matched giving scheme: Yes/ No
If yes how much will they match? £______
- What is your predicted finishing time (required for RideLondon 100 official entry)
______hours and ______minutes (max 8.5 hours allowed)
- How did you hear about The Eikon Charity?
- Please circle the statement that applies to you below:
- I have applied to the official public ballot for a place
- I have not applied to the official public ballot for a place
- Would you like to ride with friends? If so please give details (their names, whether part of a company, club etc)
- Have you supported an Eikon event before (please circle)?Yes. No.
If yes, please provide details, and how much you raised if this was a sponsored event.
- Have you taken part in a previous cycling event (please circle?)Yes. No.
If yes, please provide details
- What is your sponsorship target for the RideLondon 100 event?
- Please outline the ways in which you intend to reach this target (continue on another sheet if necessary)?
- Please state your reasons for wanting to support The Eikon Charity?
Your Declaration: I pledge to raise a minimum of £500 for The Eikon Charity in return for a Golden Bond Place in the 2014 RideLondon 100 event. I understand that any money raised by my sponsors will be transferred to The Eikon Charity without undue delay. I am happy to pay a £50 entry fee (NB: the standard cost of the event is £150) should I be granted a Golden Bond place.
Signature of applicant:
Date:
Please take a copy of this form for your records and then return by post to:Heather Boardman, The Eikon Charity, Selsdon Road, New Haw, Surrey, KT15 3HP or scan and email to (any problems call 01932 347 434).