The
Irish Hospice Foundation
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The Wil
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Join us for the challenge of a lifetime
by cycling from Canet-en-Roussillon, France
to Barcelona, Spain along the beautiful
coastline and via the spectacular Pyrenees.
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join The irish hospice
enlist the help of two wheels and
of a lifetime and take
Foundation (ihF) for the challenge
Way Cycle Challenge.
on our 2016 Wild Mediterranean
Travel from Canet-en-Roussillon to Barcelona
along the Mediterranean coast while taking in all
that The Med has to offer. The cycle route starts
in Southern France and moves through Roussillon
and further on to the foothills of the Pyrenees
and beyond to the Catalan Capital Barcelona!
Cyclists of all levels welcome
We welcome cyclists of all levels on our trip and
do this by offering two routes on many days, so
the advanced cyclist can tackle some extra
climbs in Baixa Garrotxa and Montenegre while
others can continue on with the challenge.
The Challenge
You will be cycling over 600km (incl. climbs) or
540km (ex. climbs) over the five days, while raising
vital funds for The Irish Hospice Foundation.
There will be options along the way so that those
who are keen and capable cyclists can tackle the
Coll Formic and take on the Sant Hilari Sacalm,
before we arrive into our final destination – the
Capital of Catalunya, Barcelona.
Trip Summary
Departing from Dublin on Saturday 18th June, we
travel to our hotel in Canet-Plage. The following
morning we will begin the first of five days cycling
through the picturesque towns and villages,
before spending our first night in Roses – a
town rich in Greek and Roman history.
Following on from here we head inland
towards the Pyrenees through the Baixa
Garrotxa volcanic zone! We exit the Baixa
Garrotxa toward the optional climb of Sant
Hilari Sacalm and move down the
coastline toward Calella with its 3 blue
flag beaches where we’ll be spending
the night. Our last day sees us riding
through the Parc Natural de
Montenegre before reaching the
coast again and riding along the
famous 4km Barcelona Beach.
2
a bit about Cycling Safaris
We enlist the help of the fantastic team at
Cycling Safaris to plan our route and manage
all aspects of our cycle for the entire duration
of the trip.
Cycling Safaris have been organising bike tours
in the west coast of Ireland since 1989.
Since then they have expanded their cycling
holidays to cover the length and breadth of
Ireland as well as numerous locations all
over Europe. The Irish Hospice Foundation
has been working with Cycling Safaris
from the beginning of our annual cycling
challenges back in 2009. This cycle
will be our 11th adventure with them
and we are delighted to have them on
the team again!
ITINERARY
DAY 1
SAT JUNE 18
DUBLIN TO
CANET-EN-ROUSSILLON
We set off from dublin
airport for our morning
flight to Girona. On arrival,
we will be collected and
transferred by coach to
our hotel in Canet-enRoussillon. You will be
reunited with your bike at the hotel as all bikes will have
been shipped from Dublin by Cycling Safaris. You’ll take
in the long sandy beaches here which have a lovely
atmosphere provided by the backdrop of the Pyrenees.
There are also plenty of shops, bars and restaurants
keeping this town buzzing.
DAY 2
SUN JUNE 19
CANET-EN-ROUSSILLON
TO ROSES 107KM
The first day of cycling
begins with a nice gentle
warm up along the coast
line for 15km to the
beautiful town of Collioure.
From here we head inland
and climb for almost
10km on a small quiet road that affords wonderful views
of the surrounding countryside and the ocean. We then
rejoin the coast road and cross the border into Spain.
This is a stunning ride with many great vantage points
as the road twists and turns and rises and falls
following the coastline. The Cap de Creus peninsula
provides some further undulating territory with some
unspoilt scenery together with Cadaques, long
associated with painter Salvador Dali. Roses is our
destination for tonight which has a rich Greek and
Roman history, but today it’s a modern town attracting
visitors for its beaches and restaurants.
DAY 3
MON JUNE 20
ROSES TO OLOT 110KM
The second morning sees us leaving the coast as we
head inland towards the Pyrenees. As we pass the town
of Figueres the road offers a great surface and very little
traffic as it gently climbs passing medieval towns and
villages. The wonderful medieval town of Besalu with its
12th Century Romanesque bridge and arcaded streets is
a perfect stopping point for lunch. The route then leads
us into the Baixa Garrotxa Volcanic Zone! There around
30 “cones” from extinct volcanos reside and are home
to unique flora and fauna. Olot is a town of intimate
squares, elegant shops and welcoming bars in the heart
of the volcanic zone.
DAY 4
TUE JUNE 21
OLOT TO SANT FELIU DE
GUIXOLS 119KM
After an initial short climb out of
the town, we enjoy the most tranquil
day of our trip with a long descent
across the Baixa Garrotxa. Santa
Pau, an atmospheric medieval
village in the heart of this region
will make for a worthwhile short
break. We then skirt the edge of Lake Banyoles, the largest
natural lake in Catalan with a magnificent backdrop of the
mountains. The Gavarres massif offers a lovely quiet road and
some extra climbing opportunities for those who want them (such
as the Sant Marti de Romanya or Coll de la Ganga). Soon the
coast comes back into view and our destination Sant Feliu de
Guixols can be spotted. It has a beautiful sandy beach backed by
a glorious tree lined avenue leading from the rocky headland to
the south. The traffic free Rambla Vidal is a great place to shop,
eat and people watch.
DAY 5
WED JUNE 22
SANT FELIU TO CALELLA
103KM
The coast road from Sant Feliu
again offers wonderful riding as it
exhibits great views at every corner
and is a particularly unspoilt section
of coastline. We then head inland
into the Parc Natural de Montnegre
(Black Mountain) to escape some
of the busier coastal resorts. Another optional climb here is the
Sant Hilari Sacalm, which is almost 21km long but a very
reasonable average of 3.2%. Soon we come back down to the
coast and our destination Calella with its 3 blue flag beaches
awaits.
DAY 6
THU JUNE 23
CALELLA TO BARCELONA
102KM
Our last day sees us venture inland
again to the Parc Natural de
Montnegre to avoid the busy coastal
road. Here we offer another optional
climb with the Coll Formic that goes
into the heart of the Montseny
National Park, a UNESCO biosphere
reserve (22km long, 920m Gain,
4% average). Our entry into Barcelona follows a great riverside
bike path for several kms before heading along the coast and
passing the famous 4km beach to reach our finish! We no doubt
will dip our toes in the cooling Mediterranean sea as we
celebrate how we conquered the Wild Mediterranean Way!
DAY 7
FRI JUNE 24
BARCELONA TO DUBLIN
After a wonderful celebratory
evening the night before you will
have time to explore the city of
Barcelona before we make our
short transfer to Barcelona El Pratt
Airport for our return flight to
Dublin. *Flight details to follow.
3
HOW DO I SIG N U P?
The total participation fee is €2,990 for the Wild Mediterranean Way Cycle Challenge.
This fee can only be guaranteed for participants that register and pay their registration fee by
Friday 18th March 2016. (An additional cost may occur after this date due to the fluctuation of flight
& accommodation costs)
The total participation fee of €2,990 is split
into two elements:
n Tour cost of €1,050.
n Sponsorship of €1,940.
The tour cost of €1,050 must be paid as
follows:
n Registration fee of €250 on sign-up.
n Balance of €800 due 21 days after
receipt of registration fee.
*note tour cost of €1,050 can only be
guaranteed up to 18th March 2016.
The sponsorship of €1,940 must be paid:
n First payment of €975 due 1st May 2016.
n Second payment of €965 due 31st May
2016.
inFOrMaTiOn WeeKend
An Information Weekend will take place in May
2016, and is an opportunity to meet the IHF and
Cycling Safaris team as well as other participants.
We can answer any queries you may have, give you
advice on equipment and training and give you
additional information about the trip. We will also
have a modest cycle on this day. This is a really
useful day to pick up tips and advice on the route,
training and your fundraising. We strongly encourage
you to come to the Information Weekend as it
provides an important and valuable opportunity to
discuss all matters of the cycle. This is a great
chance to get well acquainted with everyone involved
in the cycle and an opportunity to gauge your fitness
levels! All presentations from the day will be made
available to everyone after the weekend, however this
does not replace the value of being there in person.
Pre TriP BrieFinG
discounted rates:
introduce a Friend or
Sign up as a Team!
Avail of our sponsorship discount* by
referring a friend or by signing up as a
team of 4 or more. Your sponsorship
total will be reduced by €250.
A detailed pre trip briefing will be sent out to
participant’s approximately one month before
departure with all the necessary details including
travel arrangements.
“I hope you will join this wonderful trip that
raises important funds for such a worthy
cause. I look forward to seeing old friends and
making new ones as we travel across France
and Spain”.
Paul Kimmage
Journalist & former professional cyclist
* This discount offer is only available to
participants who introduce a friend who has
never participated in the Kingspan IHF Cycling
Challenge or Teams of 4 or more (this can
include previous participants) who sign-up
together.
4
Find out the difference
you can make in one
week…
The irish hospice Foundation (ihF) is a national charity striving for the best
care at end of life.
Reaching every county in Ireland, we are
bringing hospice care and principles to adults,
children and families where and when they are
needed. We receive NO core state funding and
rely upon voluntary funds – like those raised
through this cycle challenge – to maintain our
work.
Once again, the money raised through the
cycle challenge will help our Nurses For Night
Care service – which provides free night-time
nursing care in the home for those at end of
life. The nurse stays in the home through the
night providing nursing care, practical support
and reassurance to the person with a life
limiting condition and valuable respite for
family members.
2016 marks the 10th anniversary of Nurses
for Night Care and over the last decade the
service has experienced huge growth. When it
began in 2006 we provided around 100 nights
of nursing care. In 2015 this increased to over
1,500 nights of care and we expect this figure
to rise again in 2016.
A survey carried out by the IHF in 2014
revealed that 74% of people want to die at
home, but only 26% get to do so. With your
help we are trying to support more people to
spend their final days at home in their own
bed, with their family by their side.
Cyclists who have raised funds over the years
have played a major role in making this a
reality. We hope that you will continue to be a
fundamental part of the funding for this vital
service by signing up to participate in our Wild
Mediterranean Way Cycle Challenge. Each day
spent in the saddle will mean at least one
night of comfort and nursing care for those
nearing the end of life. The minimum amount
raised by each cyclist (after costs) equates to
6 nights of care. One week really does a make
a difference to those at a very vulnerable time
of life, end of life.
For more information on the work of The Irish Hospice Foundation call us on 01 6793188.
When it began in 2006 we provided
around 100 nights of nursing care.
in 2015 this increased to over 1,500
nights of care and we expect this
figure to rise again in 2016.
5
QU IC K
FACTS
n SECURING YOUR PLACE
To secure your place you will need to:
• Fill in and return the enclosed
registration form by 18th March 2016.
• Pay your €250 non-refundable
registration fee. You can do this using
the form enclosed.
• No travel arrangements will be made
until the full Tour Cost of €1,050 is paid.
Registrations taken after the 18th March
2016 may incur extra costs. This will be
made clear to participants in advance of
registration.
n SPONSORSHIP TARGETS &
DEADLINES
Total Participation Fee: €2,990
n Deadline 1: Pay registration fee – €250.
n Deadline 2: Pay balance of tour cost –
€800, 14 days after receipt of the
application form and registration fee to
secure your place on the trip.
N.B. No travel arrangements will be made
for you until the balance of the tour cost is
paid.
n Deadline 3: 1st May 2016. You must
raise and pay €975 by this date.
n Deadline 4: 31st May 2016. By this
date you must have raised and paid a
further €965, bringing your total
Participation Fee €2,990, otherwise you
jeopardise your place on the trip.
n FUNDRAISING SUPPORT
The team of professional fundraisers at the
IHF will provide you with fundraising
support including:
• Access to fundraising materials and IHF
merchandise.
• An online sponsorship account - friends,
family and colleagues can sponsor you
online through your own personalised
web page on www.mycharity.ie or
www.idonate.ie
• A direct phone number and email
address for an IHF fundraiser.
n TRAINING SUPPORT
This cycle crosses the naturally undulating
terrain of France and Spain. Although not
a flat route we will stick mostly to the
6
www.hospicefoundation.ie
if you want to move quickly and guarantee a
place, this Quick Facts page contains all of
the essential info that you will need to know
before signing up.
foothills and not seek out any great climbs.
However for the more experienced cyclists
and those looking for a greater challenge
you can tackle some hillier terrain. It has to
be recognised that strong legs and a good
cardiovascular fitness are essential - you
will be in the saddle for approximately 6
hours a day. We can provide you with the
following support to help you train:
• Professionally prepared training guide
• An information weekend that includes a
question and answer session with event
staff.
• A list of regular open cycling events to
help with your training.
Self motivation is essential!
n SUPPORT TEAM
A support team of several staff and
vehicles will organise the ride and be
responsible for:
• Transporting your bike to France and
from Spain.
• Transferring your luggage from hotel to
hotel.
• Mechanical support.
• First Aid support.
• Guiding the route.
• Organising water/snack and lunch stops.
n FOOD & ACCOMMODATION
• Accommodation is provided for every
night of the trip. It is shared twin rooms
in 3H or 4H hotels. Please indicate
anyone that you would like to share a
room with on your registration form.
Single rooms are available for an
additional fee. If you choose to stay on
for the weekend in Spain, you will be
responsible for organising your own
accommodation and flights.
• Water/snack stops. At least 2 stops (one
in the morning and one in the afternoon)
will be organised on each day of cycling.
Snack stops will consist of energy bars,
fruit, and other snacks suitable for
cyclists. However if you have particular
snacks you eat whilst cycling we
recommend you bring them along for
yourself.
• Lunch. Lunch stops are organised to take
place in Cafes/pubs, consisting of
sandwiches/baguettes. As we are
stopping in small villages for only brief
lunch stops it is not practical to have a
hot meal at the lunch stops. Lunch is not
provided on day 7.
@irishhospice
• Dinner. On days 1, 2, 3, 4, 5, 6 dinner
will be provided to the group either in
a local restaurant or in the hotels. On
day 7 participants are responsible for
buying their own dinner.
• Special dietary requirements. We are
only able to accommodate food
allergies, specific diets i.e. vegetarian,
vegan, and/or religious or medical
dietary requirements. Personal
preferences cannot be
accommodated. Please remember to
fill them in on the medical
questionnaire that you receive once
you have registered. If any individual
has particular snack preferences they
should consider bringing a quantity
with them on the trip.
n TRANSPORT
• Flight to Girona on the 18th June and
return flight from Barcelona on the
24th June. For those staying on for
extra nights you must make your own
return flight arrangements.
n WEATHER
Cycling at this time of year is usually
pleasant and sunny, but you should
come prepared for all weathers. Ensure
you have packed a waterproof cycling
top and sunscreen.
n BIKE INFORMATION
You will need to bring your own bike to
Cycling Safaris in Dublin approximately 1
week in advance of the trip for it to be
transported to France. Please ensure
that it has been recently serviced. We will
arrange for your bike to be transported
safely back to Ireland where it will be
available for collection from Cycling
Safaris in Dublin.
n WHAT IS NOT INCLUDED?
• Travel insurance – mandatory – you
must provide us with evidence of your
cover. Note: You will not be allowed
participate in the trip without Travel
insurance.
• Bike insurance
• Personal spending money
• Lunch and dinner on day 7
irish hospice Foundation
TE R MS AN D CON DITIONS
The Kingspan IHF Cycle Challenge Canet-en-Roussillon
to Barcelona rules and regulations
1. Anyone taking part in this event are acting as volunteers
for The Irish Hospice Foundation and are responsible for
and obtaining all necessary permits and permissions in
respect of public collections.
GENERAL
2. The Irish Hospice Foundation has appointed Irish Cycling
Safaris Ltd (The Company) to organise transport,
accommodation, first aid and guides for The Irish
Hospice Foundation Cycle Challenge (“the Event”) and
accepts no liability for any loss or damages howsoever
arising or for cancellation of the Event for any reason.
3. The Irish Hospice Foundation has no control over the
organisation and running of the Event and all
participants take part at their own risk.
4. The Irish Hospice Foundation has no control over what
happens on the Event from the time it departs from
Dublin to the time of its return to Dublin. The Irish
Hospice Foundation is, therefore, under no liability in
contract, negligence, or otherwise for any matter
occurring during those dates or for any loss or damage
sustained by any participant during those dates. Any
complaint must be notified directly to the Irish Cycling
Safaris Ltd within 14 days of the end of the Event, in
accordance with Irish Cycling Safaris Ltd Booking
Conditions below.
REGISTRATION FEES AND DONATIONS
5. To secure your place you will need to: Fill in and return
the enclosed registration form by 18th March 2016
along with your €250 non-refundable registration fee.
You will need to pay the balance of Tour Cost, €800, 21
days after receipt of the application form and
registration fee to secure your place on the trip. N.B.
No travel arrangements will be made for you until
the balance of the tour cost is paid. Before 1st May
2016 you must have raised and paid €975 of your
Sponsorship balance. By31st May 2016 you must have
raised and paid a further €965 bringing your total
Participation Fee to €2,990, otherwise you jeopardise
your place on the trip.
6. If you are unable to obtain the minimum target amount
of sponsorship (€1,940) you are liable to forfeit your
place on the Event and your non-refundable registration
fee of €250; donations will only be refunded directly to
the donor, upon written request by the donor.
7. You must make it clear to all your prospective sponsors
that €1,050 of the €2,990 comprises the cost of
registration and participation in the Event.
8. Should the Irish Hospice Foundation cancel the Event,
the registration fee of €250 will be refundable to you;
donations will only be refunded directly to the donor,
upon written request by the donor.
9. Should you not be able to take up your place on the
Event, donations and registration fees will not be
refundable to you; donations will only be refunded
directly to the donor, upon written request by the donor.
10. All funds raised in the name of The Irish Hospice
Foundation in connection with the Event must be paid as
soon as practicable to the Irish Hospice Foundation [in
accordance with the method of payment provisions in
the attached Application Form].
SAFETY RULES
11. Safety approved cycling helmets are compulsory.
12. You may not deviate from the official route.
13. You are to obey the local traffic regulations, traffic
officers and authorised marshals at all times.
14. You may not use your mobile phone or a personal music
system while cycling.
IRISH CYCLING SAFARIS LTD BOOKING
CONDITIONS
15. Irish Cycling Safaris LTD (The Company) accepts
bookings subject to the following conditions:
n Passports, Visas
Clients are responsible for arranging, and must be in
possession of a valid passport and any visa required
for the whole of their journey. Information about
these matters or related items (climate, clothing,
baggage, personal gear etc) is given in good faith but
without responsibility on the Company. Clients with a
European passport will not need a visa and it is the
responsibility of any other passport holders to check
with their embassy.
n Insurance &Cancellation Insurance
Travel insurance is mandatory for all clients whilst on
a tour organised by the Company. Clients together
with their personal property including baggage are at
all times solely at their own risk. Clients are wholly
responsible for arranging their own insurance. Clients
are responsible for ensuring that they are in
possession of private Travel Insurance with protection
for the full duration of the tour in respect of at least
medical expenses, injury, death, repatriation,
cancellation and curtailment, with adequate cover.
Clients should ensure that there are no exclusion
clauses limiting protection for the type of activities
included in their tour. Clients should satisfy
themselves that any travel insurance arranged
through the Company is what they require and
should arrange supplementary insurance if need be.
Clients will be deemed to have read the insurance
cover.
n Itinerary
While we endeavour to follow our itinerary there may
be exceptional circumstances when this is not
possible.We reserve the right to cancel or modify the
itinerary as necessary. Due to the nature of the trips
arrangements have to be planned well in advance, so
changes may have to be made and the Company
reserves the right to do this. Should a material change
be necessary the Company will inform you as soon as
reasonably possible. A material change includes, for
example, a significant change of destination or route
time by more than 12 hours.
n Medical Form
Prior to the event you will be asked to complete a
medical questionnaire. If you are over 60 years of age
or if you have any medical condition that could be
adversely affected by exercise, particularly a heart
condition or asthma, you must provide the Company
with a medical certificate from your doctor. By
signing this form you are confirming that, to the best
of your knowledge, your general state of health is
good and that you take full responsibility for your
health and personal well being. All medical forms will
be independently reviewed by a doctor prior to
departure.
n Minimum Age
Participants must be over the age of 18 on the day of
departure. The Company reserves the right to refuse
participation to anyone at any time without having to
disclose the reason.
n Challenge Participation
We accept your booking on the understanding that
you realise the hazards involved in this type of tour,
including injury or death, disease, loss or damage to
property, and that you come on the tour at your own
risk. We accept no liability for any injury resulting
from the hazards of cycling or any other activity
included in the itinerary, or for any other mishaps to
yourself or your property, and in particular as a
consequence of strikes, wars, riots, sickness or other
such happenings. Any independent travel
arrangements that you make are also at your own
risk. While on the cycle, illegal behaviour or conduct
considered unsuitable will not be tolerated and could
result in the participant being asked to leave the cycle
with no refund. The decision to participate in the
cycle or parts therein lies with each individual.
n Equipment
Clients taking their own equipment on tour are
responsible for any charges for transportation levied
by the transport provider including excess baggage.
You must wear a helmet on this trip. Clients are
responsible for ensuring that their bike is in a suitable
condition for participation in a cycle of this nature.
The company will endeavour to accommodate
clients, but cannot guarantee that correct tools and
spares will be available. Clients will be expected to
pay for any spares they require during the trip.
n If you have a complaint
Should you have a complaint about any of the tour
arrangements, you must tell both the relevant
supplier and the Company’s representative whilst on
the trip or within 14 days of the end of the Event. It is
only if the Company and the relevant supplier know
about problems that there will be the opportunity to
put things right.
n Delays
The timings of road, ferry or flight departures are
estimates only. We cannot accept liability for any
delay in your travel arrangements from or to Ireland
whether the cancellation or delay is caused by
adverse weather conditions, rescheduling by a
transport provider, port authority, mechanical
breakdown or industrial action. Where long delays
result in lost challenge time, no refunds are given by
hotels or suppliers. Similarly, transport providers do
not offer compensation for delays. It is in recognition
of the above that the Company’s travel insurance
policy offers some monetary compensation for
delays over 12 hours to cover lost time or delayed
return.
This Event is conceived and operated by Irish
Cycling Safaris Ltd.
[Ground arrangements are fully insured through
IrishCycling Safaris Ltd.]
Irish Cycling Safaris Ltd, Belfield Bike Shop,UCD
Belfield, D-4
WAIVER
16. Participants hereby acknowledge that they take part
in the Event and all functions and events related
thereto at their own risk. Participants hereby agree
for themselves, their executors, administrators,
heirs, next-of-kin, successors and assigns to waive
release and discharge and to neither have nor
institute any claims whatsoever against The Irish
Hospice Foundation or Irish Cycling Safaris Limited.
This waiver covers death, disability, personal injury,
damage to and loss of property of a participant and
is effective whether or not such death, injury,
damage or loss may have been caused directly or
indirectly or wholly or partly by any act or omission
including negligence, of The Irish Hospice
Foundation or Irish Cycling Safaris Limited or their
respective servants, agents and contractors and will
bind the heirs, executors and/or trustees of the
estate of a participant.
17. We are delighted that Paul Kimmage is supporting
us. We cannot however guarantee his participation.
7
IHF
The
Registration
E
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C
Y
C
C HA LLE NGE
SAT 18 - FRI 24
JUNE 2016
Are you a smoker?
PERSONAL DETAILS
Title
FORM
________________________________________________
Yes
No
IHF Official Cycle Challenge 2016 Cycling Jersey.
Please see size chart and tick size req.
Name(s)
________________________________________________
Surname
________________________________________________
Address
________________________________________________
________________________________________________
Cycle Jersey Size
S
M
L
XL
XXL
3XL
4XL
JERSEY SIZE CHART
S
HEIGHT cm 172 – 176
CHEST cm 92 -96
M
L
175 – 179 178 -182
96 – 100 100 -104
XL
181 – 185
104 -108
XXL
3XL
184 – 188 187 -191
108 -112 112 – 116
4XL
190 – 193
116 -120
________________________________________________
Date of Birth (must be over 18) __________________________________
Sex (M/F)
________________________________________________
Phone (day)
________________________________________________
Phone (mob)
________________________________________________
Fax
________________________________________________
Email address
________________________________________________
NEXT OF KIN
Title
________________________________________________
Name(s)
________________________________________________
Surname
________________________________________________
Address
________________________________________________
Will you be returning with the group on Friday 24th June?
Yes
No
If you are not returning with the group you must inform IHF before the 18th
March 2016. If travelling separately from the group you are responsible for
booking your own accommodation for the extra nights and your return flight
home. We will be happy to provide you with the name and details of the hotel
in Spain.
I have read and agree to abide by the Rules and Regulations in the
accompanying event brochure which I understand may change from time to
time and be posted on the web site www.hospicefoundation.ie. In particular,
I have read and agree to the terms of the Waiver at clause 16.
Signed: ______________________________________ Date: _____________
PLEASE NOTE: All accommodation will be shared
________________________________________________
Do you have a preference for who you wish to share with?
Yes
No Please specify name__________________________________
If you do not wish to share there will be an additional single supplement charge,
are you happy to pay this?
Yes
No
________________________________________________
Relationship
________________________________________________
Phone (day)
________________________________________________
Phone (mob)
________________________________________________
PASSPORT DETAILS
PAYMENT DETAILS
I enclose a cheque for the amount of €250 made payable to the Irish
Hospice Foundation
Please charge €250 to my
(Tick as appropriate) VISA
MASTERCARD
LASER
NB: Passport must be valid for 6 months after date of travel
Credit Card Number
Name (as on passport) _________________________________________
________________________________________________________________
Passport Number
_________________________________________
Exp Date
CVV No
________________________________________________________________
Expiry Date
_________________________________________
Place of Issue
_________________________________________
Date of Issue
_________________________________________
Nationality
_________________________________________
Address Of Cardholder
________________________________________________________________
Country of Residence _________________________________________
________________________________________________________________
INSURANCE
During the fundraising time before the cycle your fellow cyclists may wish to contact you. If you agree
to have your email shared with the other cyclists ONLY please tick the following box
Do You have travel insurance*
Yes
Name on Card
________________________________________________________________
No
* Travel insurance is Mandatory. Clients are responsible for ensuring that they are in
possession of private Travel Insurance with protection for the full duration of the tour
in respect of at least medical expenses, injury, death, repatriation, cancellation and
curtailment, with adequate cover.
Do you have any special dietary requirements?
Yes
No
If yes, please give details. Please note we can only cater for allergies not preferences
________________________________________________________________
All information on The Irish Hospice Foundation Cycle Challenge 2016 is correct at time of going to press.
Participation in the cycle is at the sole discretion of The Irish Hospice Foundation
Please return your completed application form plus deposit to:
Ruairi McGinley, Irish Hospice Foundation, 32 Nassau St, Dublin 2, Ireland
Ruairi is contactable at 01 679 3188 or [email protected]
www.hospicefoundation.ie
@IrishHospice
Irish Hospice Foundation
CHY: 6830