Wheels for Wisdom - Entry form

Terms of Participation
Wheels for Wisdom FAQ

1. Personal Details

*Title:

*First name:

*Last name:

*Address
 

*Postcode:

*Telephone:

Mobile (for on the day):

*Email:

*Emergency Name (for on the day):

*Emergency Number (for on the day):

2. Please select your distance:
DistanceNum Adults

25 miles:

45 miles:

(Childs age classed as 16 and under - young children with seats on parents bikes ride free)


3. T-shirts

If you would like to purchase a t-shirt, they are available for a suggested donation of £5 each. Please select which size and how many you require:
Sml: Med: Lrg: XLrg:

4. Payment Details

Entry total:

Donation:

£ What is this?

Grand total:

Gift Aid

If you are a taxpayer we can increase the value of your contribution by 28% through Gift Aid (25p in every pound from you and 3p in every pound from the Government from 6/4/08 to 5/4/11).

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Wilkinsons
mhs homes

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or Click here to email us.

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Registered Charity No: 284894

Friends of the Wisdom Hospice High Bank, ROCHESTER, Kent, ME1 2NU

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