2020 Credit / Debit Card Black Shuck Challenge Payment Form

Black Shuck Challenge Registration Form
Please complete all rider details below before clicking PAY NOW.

Thanks Norfolk Cycling Events

My Products *

Black Shuck 3 Loops (90 miles) £ 23.50 GBP

Quantity

Black Shuck 2 Loops (60 miles) £ 19.50 GBP

Quantity

Black Shuck 1 Loop (30 miles) £ 15.50 GBP

Quantity

Black Shuck 10 miles £ 10.00 GBP

Quantity

Black Shuck Under 16's £ 1.95 GBP

Quantity

Total £ 0.00 GBP

Address *

Rider Phone Number *

Phone Number
Emergency Contact Name *

First Name Last Name
Emergency Contact Number *
Agree to NCE Terms & Conditions *

YES = Ride NO = NO Ride
Please Note: There must be one full paying adult to 1 x under 16. Entries will be rejected if this is not the case.

Address

Phone Number

Area Code Phone Number
Emergency Contact Name

First Name Last Name
Emergency Contact Number
Agree to NCE Terms & Conditions

YES = Ride NO = NO Ride Under 16 Rider (10 miles) Under 16 Rider (2 Loops Max)

Address

Phone Number

Area Code Phone Number
Emergency Contact Name

First Name Last Name
Emergency Contact Number
Agree to NCE Terms & Conditions

YES = Ride NO = NO Ride Under 16 Rider (10 miles) Under 16 Rider (2 Loops Max)

Address

Phone Number

Area Code Phone Number
Emergency Contact Name

First Name Last Name
Emergency Contact Number
Agree to NCE Terms & Conditions

YES = Ride NO = NO Ride Under 16 Rider (10 miles) Under 16 Rider (2 Loops Max)

Address

Phone Number

Area Code Phone Number
Emergency Contact Name

First Name Last Name
Emergency Contact Number
Agree to NCE Terms & Conditions

YES = Ride NO = NO Ride Under 16 Rider (10 miles) Under 16 Rider (2 Loops Max)

Address

Phone Number

Area Code Phone Number
Emergency Contact Name

First Name Last Name
Emergency Contact Number
Agree to NCE Terms & Conditions

YES = Ride NO = NO Ride Under 16 Rider (10 miles) Under 16 Rider (2 Loops Max)
Should be Empty:

Black Shuck Challenge Registration Form