Prudential Ridelondon-Surrey 100

PRUDENTIAL RIDELONDON-SURREY 100

GOLDEN BONDAPPLICATION FORM

To apply for one of Barnardo’s guaranteed places, please complete this application form. Our places will be allocated only on the basis of the information given in this form, so please provide as much information as you can and take your time to complete it.

To gain a guaranteed place with Barnardo’s, you must commit to paying a non-refundable registration fee of £45, and to raising a minimum sponsorship amount of £650 (due one month post event)

ALL fields are mandatory

Title First Name(s) Surname

Gender Date of Birth Age on Race Day

Address

Town/City County Post code

Telephone Mobile

Email Address

Occupation Company Name

Does your company have a matched giving scheme?

(If yes, how much are they likely to match?)

Did you enter the official Prudential RideLondon-Surrey 100 ballot? Yes No

How did you hear about the Barnardo’s team? (please tick)

Prudential RideLondon-Surrey 100 Magazine Advert on Prudential RideLondon-Surrey 100 website

Barnardo’s website Google or other search engine Facebook Twitter

Already a member of Team Barnardo’s (please specify)

Workplace Other (please specify)

Why do you want to ride for Barnardo’s?

Are you a member of a cycling club? Yes No

Have you taken part in any other cycling events?

Have you previously taken part in any fundraising?

What is your target finishing time? (hours) (minutes)

(Please note that you must complete the event in 9hrs or you will be moved to a shortened route on the day by race organisers)

How many days a week do you cycle? 0 1-3 4-6 7

How many times a week do you participate in 30mins of exercise? 0 1-3 4-6 7

If you are sucessful with your application for a Barnardo’s guaranteed place, we want to offer you a high quality sports top to wear while you train and race. Please let us know what size you would like.

Female XS S M L XL XXLMale S M L XL XXL

FUNDRAISING

How much do you pledge to raise for Barnardo’s?

The minimum sponsorship for a Barnardo’s guaranteed place is £650 which you must aim to reach.

Please outline exactly how you plan to raise the minimum sponsorship of £650. Please remember that the information you provide will determine whether you are offered a place on the Barnardo's team.

realistic figure ofwhat you expect to raise from each approach, who you will be approaching to support you.

TERMS AND CONDITIONS, AND DECLARATION

Barnardo's values your support and promises to respect your privacy. The data we gather and hold is managed in accordance with the Data Protection Act (1998). We will not disclose, or share personal information supplied by you, with any third party organisations without your consent. We only collect personal information when you specifically and knowingly provide it to us. The only information we gather on this site is your name, your age, your regional location, how you heard about us and your email address.

We would like to contact you about Barnardo's work and fundraising activities. Please confirm that you are happy for us to do this.

Yes

No

I confirm that my name and video footage or photographs taken during my participation may be used on Barnardo's publicity and fundraising to publicise the event.

Barnardo's values your support and promises to respect your privacy. The data we gather and hold is managed in accordance with the Data Protection Act (1998). We will not disclose or share personal information supplied by you, with any third party organisations without your consent. We would like to keep you informed about the vital work we do, if you do not want to receive this information please let us know by ticking this box.

Do you agree to the above conditions. *

Yes

No

Barnardo's adheres to the Fundraising Promise and Fundraising Standards Board guidelines. Barnardo's Registered Charity Nos 216250 and SC037605

Print Name:

Signed: Date:

THANK YOU FOR YOUR INTEREST IN JOINING THE BARNARDO’S PRUDENTIAL RIDELONDON-SURREY 100 TEAM.

Please return your completed application form via email to . Alternatively, you can print off this application form and send it to The Events Team, Barnardo’s, Tanner’s Lane, Barkingside, Ilford, IG6 1QG. If you have any questions about the application process, please call 0208 498 5727.