<p> CSSC EVENT ENTRY FORM</p><p>Event: Lee Valley Track Taster Venue: Lee Valley Velo Park, Queen Elizabeth Olympic Park Date of event: Saturday 20 August 2016 Start time: 12pm Event</p><p>Please complete all sections in BLOCK CAPITALS. CSSC membership numbers must be included. You may find it helpful to ‘Tab’ from one field to another.</p><p>Section 1: Your Details (Delete as applicable) Title: Forename: Surname: Gender: Over 18: Yes No Home Address </p><p>Postcode CSSC membership no. Home Telephone no. Work Telephone no. Mobile Telephone no. Email </p><p>Next of Kin NoK Contact Tel. no. </p><p>Age on Day of Event Height – required for bike size FT INS</p><p>Yes No Have you ridden at the Velodrome before? </p><p>Section 3: Entry Fee</p><p>CSSC Members: £20.00 ………… Non-Members: £35.00 ………….. Junior 12-18yrs: £25.00 …………..</p><p>To pay by card please call 01494 888434 quoting the event I.D 3599 and name of event</p><p>All cheques should be made payable to ‘CSSC Ltd’ and should accompany the entry form. Please do not send cash. </p><p>Refund Policy: No refunds will be given from a month prior to the event.</p><p>Payment Method: Total Amount: £ Section 4: Event Information </p><p>These one hour taster sessions are an exciting one off introduction to track cycling where you will be coached in the use of a fixed wheel bike and the basic skills required to safely ride the velodrome track. Tasters are a fun, one-off experience. Track Tasters do not form part of the accreditation process you will need to complete Stage1 (introduction) if you wish to complete the four stage accreditation pathway, which will allow you to progress to racing. • Bike and helmet hire is included, however you are required to supply or hire from the venue track mitts. • Shoe hire is optional, it is not included in the cost of your taster session. • If you're unsure if the taster sessions are for you please see Lee Valleys FAQs </p><p>Section 5: Important Information</p><p>Medical: Please let us know if you have any physical or medical conditions Yes/No (Delete as applicable)</p><p>If yes, please give details Any Dietary Requirements</p><p>IMPORTANT: These events are active and players should be aware of the physical activities involved. CSSC reserves the right to cancel the event if under subscribed.</p><p>All CSSC members taking part in the event are covered by CSSC Sports and Leisure Public Liability Insurance. Please note that this policy is NOT a Personal Accident Policy. Members are encouraged to take out their own insurance policy.</p><p>This event is open to your friends or family members. As a reminder, under our Linked membership scheme, up to three of your friends or family members can join CSSC and take part in our events at members’ rate. Membership is also available to staff working in the Public Sector such as NHS, local government, teachers, the police, fire fighters and HM Armed forces personnel. </p><p>Once entry forms and payment are received and processed an acknowledgement email will be sent out with further information a week before the event.</p><p>Signed: Date: </p><p>Please send all entries to: </p><p>Post: Jennifer Yarrow CSSC Sports & Leisure Compton Court 20-24 Temple End High Wycombe Bucks HP13 5DR</p><p>Email: [email protected] Photocopied forms will be accepted</p><p>Office use only: Event ID: 3599 Date entry received: …………………. Date acknowledgement sent: ………………….</p>