Taff Trail Bike Ride Saturday 12 September 2015

TaffTaff Trail Trail BikeBikeBike RideRide Ride 50 50MilesMiles Miles from from from Brecon Brecon 50or 25 Miles miles from from Brecon Merthyr to Sophiato Gardens to SophiaSophia Gardens Gardens Saturday 12 Sep 2015 Limited transport available - to Brecon

CycleCycle with with us from us from the heart the heart of the of Brecon the Brecon Beacons, Beacons, Cycle with us from the heart of the Brecon Beacons, throughthrough heritage heritage landscapes landscapes on virtually on virtually traffic-free traffic-free through heritage landscapes on virtually traffic-free routesroutes all the all waythe wayto Cardiff. to Cardiff. routes all the way to Cardiff. www.stdavidshospicecare.org 01633 851051 Supported by:

Registered charity Find us on: Supported by: Registered charity Find usFind on: us on: SupportedSupported by: by: Registerednumber: 1010576 charity number:Registered 1010576 charitynumber: 1010576 Find us on: Supported by: number: 1010576 Taff Trail Bike Ride 12 Sep 2015 – Registration Form Meeting at Brecon High School, in the Market Town of Brecon. We will be cycling 50 or 25 miles through open moorlandTaff Trail of the Brecon Bike Beacons Ride and 2012a wide variety Registration of urban and suburban Form landscapes, passing close to Taff Trail BikeTaff RideMerthyrTaffWe Trail will be Tydfil,Trail2012 cycling Bike ,50 Bike miles,Registration Ride meeting Ride and 2012 then at the 2012finishing theatre Registration Form in at Registrationthe Bute market Park/Sophia town of Brecon,Form Gardens Form through Cardiff. open moorland of the >Brecon This is Beacons not a Race! and a wide variety of urban and suburban >landscapes We hope that passing you will close endeavour to Merthyr to raise Tydfil as muchand We will be cycling 50 miles,We meetingwillWe be cyclingwill at bethe cycling 50 theatre miles, 50 in meeting miles, the market meeting at the town theatre at theof Brecon, theatre in the marketthrough in the market town open of moorland town Brecon, of Brecon, through of the through open moorland open moorland of the of the >Pontypridd Bicycle Helmets and then must finishing be worn at the at all Sophia times Gardens during in Cardiff.sponsorship as possible to support our work in the Brecon Beacons and a wideBrecon varietyBrecon Beaconsthe of event urban Beacons and and a wide and suburban varietya wide varietylandscapes of urban of and urban passing suburban and close suburban landscapes to Merthyr landscapescommunity. passing Tydfil passingand close to close Merthyr to Merthyr Tydfil and Tydfil and Pontypridd and then finishingPontypridd at>>Pontypridd  The theThe and rideSophia ride then will will and beginGardens finishing have then at a 10.00am finishing rolling in at Cardiff. the start Sophia at the from Sophia Gardens 8.30am Gardens in to Cardiff. in Cardiff.> > T-shirtsOn receipt are ofavailable this entry for purchaseform St David’s via Fundraising Hospice Care will > T-shirts9.30am are prompt. available for purchase >  Teams issue sponsor are encouraged forms to take part. > The ride will begin at 10.00am> The ride> The will ridebegin will at begin 10.00am at 10.00am > On receipt of this entry form> On Streceipt David’s> On receiptof Hospicethis entry of this Care form entry will St formDavid’s St David’sHospice Hospice Care will Care will >>  TeamsTransport are encouraged must be booked to take atpart the time of registration, > > OnTo registerreceipt ofplease your completeentry form, the St David’sform below Hospice and returnCare will to: > T-shirts are available for >purchase T-shirts> T-shirts are available are available for purchase for purchase issue sponsor forms issue sponsor issue sponsor forms forms > Theplaces route are will limited be marshalled to 150 (Cardiff and refreshments to Brecon will only). be issue Taff Trail sponsor Bike Rideforms, 2012, together Fundraising with confirmation. Department, > Teams are encouraged to> Teams take part>>  areTeamsTransport encouraged are encouraged NOT to Available take partto take for> part To the register 25ml route,please Merthyr. complete> To theregister> > form To registerregister please below completeandplease, please return complete complete the to: form the the below form form and below below return and and to: return return to: available along the way St David’s Hospice Care, Blackett Avenue, > The route will be marshalled> The and route>>  refreshmentsTheThe will route collection be marshalled will bewill pointmarshalled be and for refreshments transport and Taff refreshments Trail for will Bike Brecon be Ride will will2012, be be Fundraising atTaff Trail to: Taff Bike Taff Department, Trail Ride Trail Bike Bike2012, Ride Ride Fundraising 2012, 2015, Fundraising Fundraising Department, Department, > The collection point for transport to Brecon will be at Newport, NP20 6NH available along the way available availableSophia along the Gardens, along way the way Cardiff at 7.30am St David’s prompt Hospice Care, Blackett St David’s Department, St Avenue, David’sHospice Hospice Care, St David’s Blackett Care, Hospice Blackett Avenue, Care, Avenue, Blackett Avenue, Sophia Gardens at 8.30am prompt > The minimum age for this event is 14, anyone under 16 > The collection point for transport> The collection> The to(CF11 Brecon collection point9LJ) will for bepoint transport at for transport to Brecon Newport, to Breconwill be NP20 at will 6NHbe at Newport, Newport, Newport, NP20 6NH NP20 NP20 6NH or register online via our website. > The bike ride is for both men and women, for all levels of must be accompanied by a parent or guardian Sophia Gardens at 8.30am Sophia prompt> GardensSophia The route Gardens at will 8.30am be at marshalled 8.30am prompt prompt and> The refreshments minimum age will for be this > Theevent minimum> > is The 14, minimumanyone age for under thisage eventfor16 this is eventevent 14, anyone isis 14, 14, anyone anyone under 16 under under 16 16 fitness and can be taken at your own pace, it is not a race! > If an individual is younger than 16 years of age a parent or > The bike ride is for both men> The and bike> Thewomen,available ride bike is for forride along both all is levels for the men both way. of and men women, and must women, for beall levelsaccompanied for all of levels of by must a parent be must must accompanied or guardian bebe accompanied by a parent by a orparent guardian or guardian.guardian >>  EntryThe bike is £10pp ride is and suitable an additional for both men£5 pp and if transport women, toof the >  If guardian an individual must is also younger sign the than disclaimer 16 years of below age a parent or fitness and can be taken at fitness your own andfitness pace,can and be it takeniscan not be ata takenrace! your ownat your pace, > If own an it individual pace,is not ita israce! isnot younger a race! > than If an individual16 > Ifyears an individual of is age younger a parentis younger than or 16 than years 16 of years age a of parent age a orparent or startmoderate is required to experienced (non-refundable). levels of We fitness, hope and that can you be will > guardianIf you require must any also further sign the information disclaimer onbelow the event, > Entry is £10pp and an additional> Entry is> £5 Entry£10pp pp ifis andtransport£10pp an additionaland to an the additional £5 pp ifguardian £5transport pp if transportmust to the also tosign the the guardian disclaimer guardian must below also must sign also the sign disclaimer the disclaimer below below endeavourtaken at your to raiseown pace. as much sponsorship as possible to > Ifplease you require contact any us further on 01633 information 271364 on the event, please start is required (non-refundable). start is requiredstart We ishope required (non-refundable). that you (non-refundable). will We> hopeIf you We that require hope you that any will youfurther will> informationIf you require> If you on requireany the further event, any furtherinformation information on the event, on the event, > supportEntry is our £25pp work with in the transport community or £15pp without contactemail [email protected] us on 01633 851051 endeavour to raise as much endeavour sponsorship endeavour to raise as possible toas raise much as to sponsorship much sponsorship please as possible contact as possible to us on 01633to please 271364 contactplease contact us on 01633 us on 27136401633 271364 transport (Non Refundable). email:or visit [email protected] our website www.stdavidshospicecare.org support our work in the community support support our work our in thework community in the community email [email protected] email [email protected] oremail visit [email protected] our website www.stdavidshospicecare.org or visit our website www.stdavidshospicecare.org or visit our or visit website our website www.stdavidshospicecare.org www.stdavidshospicecare.org Sponsor online: www.justgiving.com/sdf/raisemoney Sponsor online: www.justgiving.com/sdf/raisemoneySponsorSponsor online: www.justgiving.com/sdf/raisemoneyonline: www.justgiving.com/sdf/raisemoney Where did you hear about this event? Where did you hear aboutWhere this event? didWhere you didhear you about hear this about event? this event? Participant Mr/Mrs/Miss/Ms First Name Surname Participant Mr/Mrs/Miss/MsParticipantParticipantFirst Mr/Mrs/Miss/MsName Mr/Mrs/Miss/MsFirst NameFirst Name Surname SurnameSurname Address Address AddressAddress Postcode Postcode PostcodePostcode Telephone Mobile Telephone TelephoneTelephone Mobile Mobile Mobile Email

Email EmailPleaseEmail read and sign: I understand that this is a sponsored event and will endeavour to raise sponsorship to support the work of St David’s Hospice Care. I certify that I release ISt would David’s likeHospice to take Care, andpart their in agents,(please officials tick): and volunteers 50 mile for any Bike injury Ride / loss caused throughTransport my participation Required in this event. 25 I take mile part Bike entirely Ride at my from own risk. Merthyr I agree Please read and sign: I understand thatPlease this read is aPleasethat sponsored and I shouldsign: read I understandeventand seek sign: medicaland I understandwill that endeavour advice this is from thata sponsored to mythis raise general is sponsorshipa sponsored event practitioner and towillevent support endeavour if andI am will inthe any endeavour workto doubtraise of Stsponsorship as David’sto to raise my physical Hospicesponsorship to support abilityCare. to the Ito certifysupport participatework thatof the St I David’sreleasework in this of event. HospiceSt David’s I certify Care. Hospice thatI certify I Care. give that full I certify I consent release that for I release any St David’s Hospice Care, and their agents,St David’s officials HospiceStphotographic/video David’s and volunteersCare, Hospice and their Care, for materials any agents, and injury their to officials /be lossagents, held caused and and officials volunteers used through andby St volunteersmy for David participationany’s injury Hospice for / any loss in Care injury thiscaused forevent. / loss all through and causedI take any partmy purposes through participation entirely my connected at participation my in own this withrisk.event. inIpublication agree thisI take event. part and entirelyI take commercialisation. part at myentirely own atrisk. my I agree own risk. I agree that I should seek medical advice fromthat my I should generalthat seek practitioner I should medical seek advice if medicalI am infrom any advice my doubt general from as to my practitioner my general physical practitioner if ability I am in to any participate if I doubt am in anyas into doubt this my event.physical as to I my certify ability physical that to participate Iability give full to consentparticipate in this event. for inany thisI certify event. that I certify I give full that consent I give full for consent any for any photographic/video materials to be photographic/videoheld and usedParticipantphotographic/video by St Davidmaterials’s Hospice to materials be held Care andto for be usedall held and by and any St used Davidpurposes by’s HospiceSt connectedDavid ’Cares Hospice forwith all publication Care and anyfor all purposes and anycommercialisation. connected purposes connected with publication with publication and commercialisation. and commercialisation. Participant ParticipantParticipantSigned: Taff TrailDate: Signed: Signed:Parent/GuardianSigned: if child is under 16 (minimum age 14) Date: Date: Date: Parent/Guardian if child isParent/Guardian under 16Parent/GuardianSigned: (minimum if child age is if14) underchild is 16 under (minimum 16 (minimum age 14) age 14) Bike RideDate:

Signed: Signed:St Signed:David’s Hospice Care values your support and promises to respect your privacy. Date: Date: ChildDate: Age: The data we gather and hold is managed in accordance with the Data Protection 50Donor Miles number from Brecon (Internal use only) St David’s Hospice Care values yourSt support David’s and HospiceStAct David’spromises (1998). Care Hospice If to youvalues respect do Care yournot your valueswish support privacy. to your receive and support promises any mail and to itemspromises respect from toyour us, respect please privacy. your tick: privacy. to Sophia Gardens The data we gather and hold is managedThe data in accordance weThe gather data andwithwe gather hold the Data is and managed Protection hold is in managed accordance in accordance with the DataDonor with Protection the number Data Protection Donor numberDonor number Act (1998). If you do not wish to receiveAct (1998).any mailAct If items you (1998). do from not If you us,wish please do to not receive tick:wish anyto receive mail items any mailfrom items us, please(Internal from tick:us, useplease only) tick: (Internal use(Internal only) use only) Payment I enclose a cheque (made payable to St David’s Hospice Care) Please debit my debit/credit card

Payment I enclosePayment a chequePaymentAmount (made payableI enclose toI enclose Sta chequeDavid’s£10 a pp/ Hospice cheque (made £15 payableppCare) (made (if transport topayable St David’sPlease to required) St Hospice David’s debit HospiceCare) my debit/credit Care) Please card debitPlease my debit debit/credit my debit/credit card card

Amount £10Amount pp/ £15CardAmount pp type (if transport£10 required)VISA pp/£25pp£10 £15 pp/ pp with (if£15 transport pp (if transportMASTERCARD required) required) £15ppDELTA without transport MAESTRO

Card type VISA Card typeCard No.type MASTERCARDVISA VISA MASTERCARDDELTAMASTERCARD MAESTRODELTA DELTA MAESTROMAESTRO Cycle with us from the heart of the Brecon Beacons, Card No. Card No.Card No. Valid from Expiry through heritage landscapes on virtually traffic-free Valid from Valid fromValid from Expiry Expiry Expiry Issue No. (If applicable) Security No. (Last 3 digits on back of card) routes all the way to Cardiff.

Issue No. (If applicable) Issue No.Issue (IfSecurity applicable) No. (If No. applicable) (Last 3 digits on back ofSecurity card) Security No. (Last 3 No. digits on(Last back 3 digits of card) on back of card) Alternatively, to make a payment over the telephone, please call 01633 271364 Alternatively, to make a payment over the telephone, Find us on: In partnershipSupported with: by: Registered charity Alternatively, to makeAlternatively,pleaseAlternatively, a payment call 01633to make over to 851051 make thea payment telephone, a payment over please overthe telephone, the call telephone, 01633 please 271364 please call 01633 call 01633 271364 271364 number: 1010576