Full name *

as on your passport

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Have you participated in Cycle Slam before? *

Yes

No

Which stage of the 2024 Cycle Slam ride are you signing up to? *

*dates are subject to change based on availability

Core rider - completing both stages of the trip(13th April to 25th April 2024*)

Stage 1 rider - completing week 1 of the trip (13th to 19th April 2024*)

Stage 2 rider - completing week 2 of the trip(19th April to 25th April 2024*)

How often do you currently cycle? *

Multiple times a week

Once a week

Fortnightly

Every 3-4 weeks

Monthly

Less frequently

Never

If you are signing up to be a stage rider, would you like a single room? *

A single room costs £300 on top of the entry fee

Yes

No

By signing up to Cycle Slam, I agree I am a competent rider with the ability and fitness to complete a long duration, high intensity cycling event. I also agree to have a medical form completed by a doctor before the event, who can confirm I am physically fit and able to participate. *

Yes

By signing up to Cycle Slam, I also agree that I can perform basic bike maintenance. *

Yes

Emergency contact name *

First Name

Last Name

By ticking this box and signing up to Cycle Slam 2024, I agree to provide Dallaglio RugbyWorks the personal information required for the event including, but not limited to passport details, full name and address, and medical information. For information on how we store and use your data, please refer to our privacy policy

https://www.dallagliorugbyworks.com/privacy-policy

Yes

By ticking this box, I consent for Dallaglio RugbyWorks to send me an invoice for the cost of the trip and will pay a £500 non-refundable deposit within 4 weeks of receipt, and the remaining entry fee by 5th September 2023. *

Yes

By ticking this box, I consent for Dallaglio RugbyWorks to contact me via telephone or email about upcoming events, including Cycle Slam 2024.

Yes

By signing up to Cycle Slam 2024, I agree to the event terms and conditions *

Scroll up to read the Terms & Conditions or visit this link: https://static1.squarespace.com/static/62076e7c63f4f06142ff5cb6/t/6426f40b50998150828e2fe5/1680274444033/Dallaglio+Cycle+Slam+2024+Ts%26Cs+.pdf

Yes