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Equilibrium - Self Harmony

London to Paris Sponsored Bike Ride Application Form

Please fill in and submit this forum if you are interested in joining us for the London to Paris Sponsored bike ride. This form is an application of interest and NOT an event registration form. If you are interested in doing the ride as a family or group then please fill out a form for each individual.


Full Name

Age

Gender
Male Female

EQ Username (if applicable)

City/Town
 

Email

Country

Occupation


Do you have any health or mental conditions which could limit your ability to complete the ride or put you in any danger?

Yes No
If yes, please state which

Do you self harm?

Yes No


How fit are you?

Unfit
Not very fit
Quite fit
Fit
Athlete


Are you a regular cyclist?

Yes No

Have you done a long distance cycle ride before?

Yes No

Do you have your own bike?

Yes No


Are you willing to be filmed/interviewed?

Yes No

Do you have a valid passport?

Yes No

How do you want to participate?
(Please tick all that apply)

Cyclist
Support Vehicle Driver
First Aid
Cycle Mechanic


How did you first hear about the bike ride?


Do you have any comments or questions regarding the event?

Any information you disclose to us will be kept confidential unless otherwise stated or pre-arranged.
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