EMERGENCY CONTACT DETAILS

This form need only be completed on your first race and will be kept by the Organisers  for the duration of the series.  Please advise any change of details.



 PROGRAMME DETAILS :

Location : Goodwood Motor racing Circuit, Westhampnett, Chichester PO18 0PH         

                          

PARTICIPANT DETAILS :


Name : ______________________________________________

Date of birth  _____/_____/_____               Sex : M                    F    

Address :         ___________________________________________

  

                        ___________________________________________

Postcode :  _____________

British Cycling Membership Number : _________________________

Home Telephone : _____________________________________

Email address :     __________________________________________



Date : ________________________             Signature : ____________________________

EMERGENCY CONTACT DETAILS :

Name : ______________________________         Contact Number___________________

(Should be a contactable number and not your own mobile)


MEDICAL INFORMATION :

Please make a note in the box below of any medical condition you feel we need to know about e.g. asthma.  If you have any concerns about your participation in any form of physical activity you should consult your GP before beginning the series.