Coast to Coast application form

Title *

Name *

First

Last

Parent full name (If participant is under the age of 16)

First

Last

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Tell us all about your Coast to Coast challenge!

What is your connection to MS-UK?

Tell us a bit about yourself and why you are choosing to support MS-UK

Where did you hear about this challenge?

Would you like to sign up to MS-UK’s e-newsletter to stay up to date with the latest information about the charity and new fundraising opportunities?

Yes
No

Terms and Conditions *

I agree to the terms and conditions

All participants that raise £100 (excluding Gift Aid) will receive an exclusive Coast to Coast medal All fundraising pages must be set up solely for MS-UK Participants under the age of 16 must be entered by a parent/guardian and must be accompanied by a parent/guardian whilst taking part in the event Any photographs or videos that are sent to MS-UK may be used on our website and social media channels for publicity purposes. Please let us know if you do not wish for us to use any pictures that you send us Any fundraising events undertaken during your Coast to Coast challenge are done so at your own risk and MS-UK cannot take responsibility for anything that may happen outside of our control All fundraising for this event must reach MS-UK by Friday 14 October 2022 By participating in MS-UK’s Coast to Coast challenge, you agree to being a responsible cyclist You should wear a helmet at all times when riding a bicycle Be aware of the Highway Code and obey it at all times