Early Education ‘PrudentialRideLondon-Surrey 100’ Application Form

Sunday 31 July 2016

Allocation of Early Education’s place will depend entirely on the information given on this form, so please provide as much as you can.

About you
First Name / Last Name
Address
Email
Daytime Contact Number / Date of birth
Company / Occupation
Predicted finishing time (max 9 hours)
How did you hear about Early Education’s Prudential RideLondon-Surrey 100 place?
Your Cycling & Fundraising Experience
How many cycling events have you completed? (Please give names)
If you have taken part in any other charitable fundraising activities, please provide details of the most recent below:
Date / Amount Raised / How did you raise this amount
We are asking the rider awarded with Early Education’s place in the Prudential RideLondon-Surrey 100to raise a minimum of £750. Please tell us how much you think you could raise if awarded the place?
Please detail how you plan to raise the minimum amount
Why would you like to cycle Prudential RideLondon-Surrey 100 for Early Education?
Registration Terms and Conditions
If selected as Early Education’srider I pledge to raise the minimum sponsorship of£750. I understand that all monies raised in our name must be paid to Early Education.
1. We require registration fee of £50, which is refundable upon raising the minimum sponsorship.
2. All sponsorship monies must be paid to Early Education by Monday 30th September 2016.
3. If you are unable to meet the minimum sponsorship requirement you may choose to make up the balance yourself.
4. All the sponsor forms, Gift Aid declarations and monies should be forwarded to Early Education. Early Education requires you to raise money online via
5. All funds raised in connection with Early Education must be payable to Early Education in sterling.
6. You must be at least 18 years old on the date of the event to register.
7. You must not suffer from alcohol or drug dependency, nor have any criminal convictions.
8. You must bring and wear a cycling helmet at all times when cycling. Early Education is not able to provide you with any cycling equipment.
9. You must not use your Prudential RideLondon-Surrey 100space for any other commercial gain, or use the challenge to fundraise for any registered charity other than Early Education.
10. The interests and good reputation of Early Education may, at its sole discretion, withdraw a participant if it believes that it is the best interests of the charity to do so.
Your declaration
I understand that if selected to be Early Education’s rider in the Prudential RideLondon-Surrey 100, I pledge to raise the minimum sponsorship of£750. I agree to all of the above terms and conditions of entry.
Signed / Date

Please send a copy of your form to or Early Education, 136 Cavell Street, London E1 2JA.

Thank you so much for expressing interest in taking part in Prudential RideLondon-Surrey 100 on behalf of Early Education.