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An Post Tour de Burren 2012 - Sligo Sport and Recreation Partnership

An Post Tour de Burren 2012 - Sligo Sport and Recreation Partnership

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The Blackhead Battle 66 km<br />

Fr. Ted’s Day Out 162km<br />

~ Burnin <strong>Burren</strong> 108km<br />

Entry Form<br />

PLEASE COMPLETE THIS FORM IN BLOCK CAPITALS<br />

Note: One Cyclist per form only. Please enclose correct fee for your chosen event. Please send your completed form & cheque / postal or<strong>de</strong>r to: <strong>An</strong> <strong>Post</strong> <strong>Tour</strong> <strong>de</strong> <strong>Burren</strong>,<br />

Clare <strong>Sport</strong>s <strong>Partnership</strong>, Unit 1, Westgate Business Park, Ennis, Co. Clare. CLOSING DATE FOR RECEIPT OF ENTRIES IS Wed. 15th June, <strong>2012</strong><br />

Name: Address: Tel: DOB M/F<br />

________________ ___________________________ _________________ ___________ ____<br />

Email:<br />

_______________________________________________<br />

Signature of Parent/Guardian:<br />

______________________________________________<br />

Please select route:<br />

The Blackhead Battle<br />

66km<br />

Burnin <strong>Burren</strong><br />

108km<br />

Fr. Ted’s Day Out<br />

162km<br />

Fee Enclosed €________ Cheque <strong>Post</strong>al Or<strong>de</strong>r Other __________<br />

Cycling Irel<strong>and</strong> Club Membership Number:<br />

How did you hear about <strong>An</strong> <strong>Post</strong> Cycle Series (please tick one or more)<br />

Please tick this box if you would like to receive further information<br />

Newspaper Promotional Flyer Other: from Clare <strong>Sport</strong>s <strong>Partnership</strong>, on similar events.<br />

Radio Word of Mouth ................................ Are you a member of a cycling club Yes No<br />

Internet Cycling Irel<strong>and</strong> ................................ If yes, please provi<strong>de</strong> club name: ..................................................................<br />

Entry Fee is non refundable<br />

Aillwee Cave Family Loop Entry Form<br />

12Km Aillwee Cave Family Loop | PLEASE COMPLETE THIS FORM CLEARLY IN BLOCK CAPITALS |<br />

Note: One family per form only. Fee €2 per participant.<br />

OR<br />

Name: Address: Tel: DOB M/F<br />

1________________________ ___________________________ _________________ ___________ ____<br />

2. ________________________ ___________________________ _________________ ___________ ____<br />

3.________________________ ___________________________ _________________ ___________ ____<br />

4.________________________ ___________________________ _________________ ___________ ____<br />

5.________________________ ___________________________ _________________ ___________ ____<br />

6. ________________________ ___________________________ _________________ ___________ ____<br />

Please i<strong>de</strong>ntify Parent/Guardian from the above group <strong>and</strong> sign below:<br />

Name:<br />

Signature of Parent/Guardian:<br />

Email:<br />

______________________________________________<br />

______________________________________________<br />

_______________________________________________<br />

Fee Enclosed €________ Cheque <strong>Post</strong>al Or<strong>de</strong>r Other __________<br />

• Entry fees are non refundable.<br />

How did you hear about <strong>An</strong> <strong>Post</strong> Cycle Series (please tick one or more) Please tick this box if you would like to receive further information<br />

Newspaper Promotional Flyer Other: from Clare <strong>Sport</strong>s <strong>Partnership</strong>, on similar events.<br />

Radio Word of Mouth ................................ Are you a member of a cycling club Yes No<br />

Internet Cycling Irel<strong>and</strong> ................................ If yes, please provi<strong>de</strong> club name: ..................................................................<br />

continued overleaf

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