CROKER TO CORoFIN CYCLE

REGISTRATION FORM

Name

First Name

Last Name

Main Contact Number

Level of Cycling

Pick Your Distance

Other Distance

Please Specify

Will you be departing Corofin with the rest of the cyclists on the morning of the cycle availing of the bus to Croke Park?

Bikes will be brought to Croke Park ahead of the cyclists in a secure truck do you want to avail of this?

Are you a member of Cycling Ireland

Do you have insurance that covers you during the cycle?

How do you intend on raising minimum €250

If Sponsorship is YES please input Address

Emergency Contact