RideLondon-Surrey 100
Golden Bond Application Form
To apply
To apply for our Charity Ballot place please complete all three pages of this form and
return it to Naomi Mardon
-
by post: Mothers’ Union, Mary Sumner House, 24 Tufton Street, London, SW1P
3RB
by email: [email protected]
If you are offered a place we will require you to pay a £50 registration fee and raise a
minimum of £500 (excluding Gift Aid).
Our places in the RideLondon-Surrey 100 are very precious and we need to
ensure that we offer them to people who are confident they will complete the
challenge and raise as much for Mothers’ Union as possible. To increase your
chance of a place, please ensure you thoroughly complete the sections about
your connection to Mothers’ Union and taking part in the Marathon. Use
additional sheets if necessary.
Your connection to Mothers’ Union
1. How did you hear about Mothers’ Union?
2. Have you taken part in a fundraising event for Mothers’ Union before? YES/NO
If yes, when?
3. Are you a Mothers’ Union Member? YES/NO
If yes, please confirm your branch and diocese
2017 RideLondon-Surrey 100
Gold Bond Application Form
Personal details
Title
(Mr/Mrs/Ms/Miss)
Surname
Forenames
Address
Postcode
Date of Birth
Home telephone
Work telephone
Mobile telephone
Email
Employer details
Name
Type of business
Position held
Will your
employer:
Sponsor you?
Match your fundraising
total?
Is there a company
newsletter/magazine/intranet?
YES/NO
YES/NO
YES/NO
If yes please give the editorial contact
name and phone number
Taking part in the RideLondon-Surrey 100 for Mothers’ Union
Why would you like to run the RideLondon-Surrey 100 for Mothers’ Union?
How do you plan to raise at least £500 sponsorship?
Have you applied to any other charities for a place in the RideLondon-Surrey 100?
YES/NO
2017 RideLondon-Surrey 100
Gold Bond Application Form
Medical history and fitness
The cycle race is a strenuous activity and the decision to take part is one that should not
be taken lightly. If you are not a regular cyclist, over 60 years, have any medical
condition that could be adversely affected by exercise, particularly a heart condition, or if
you are in doubt about your health we recommend you seek professional advice about
your fitness and training requirements.
I confirm that to the best of my knowledge my general state of health and fitness is
good and I take full responsibility for my safety.
Signature
Date
Your declaration
Conditions of entry
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
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For a Golden Bond Entry place in the RideLondon-Surrey 100 we require a
registration fee of £50.
You must be at least 18 before the date of the race.
All funds raised for Mothers’ Union through the event must be payable to Mothers’
Union.
You take part at your own risk.
I consent to Mothers Union contacting me via telephone, letter or email for any matter
relating to my fundraising and my participation in this event.
I give Mothers’ Union permission to use any photographs/videos taken of me to raise
awareness and/or money for its work and/or events.
I pledge to raise a minimum of £500 (excluding Gift Aid) for Mothers’ Union in return
for a Charity Ballot place in the 2017 RideLondon-Surrey 100. I understand that any
money raised from my sponsors will be transferred to Mothers’ Union without any
undue delay. I am happy to pay a £50 entry fee when I register for my place.
I am fully aware that training for the RideLondon-Surrey 100 takes months of
commitment and I am confident that, with training, I will be able to finish the route in
the nine hour time limit imposed by the RideLondon-Surrey 100 organisers.
Signature
Date
Thank you for your interest in running the RideLondon-Surrey 100 for Mothers’
Union. Upon receipt of your completed application form we will let you know as
soon as possible if we are able to offer you a Golden Bond place in the 2017
RideLondon-Surrey 100.
2017 RideLondon-Surrey 100
Gold Bond Application Form