Roger Casements GAC
Portglenone
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PG100
Cycle Registration
MINI PG100, 5k & 10k Registration
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Roger Casements GAC, Portglenone
Home
PG100
Cycle Registration
Cycle Registration
Please Register for PG100 by completing the form below.
PG100 Registration
Who are you registering?
*
Select an option
Me, 18+
Other Adult, 18+
Minor, U18
By selecting this box, you are indicating that you are the parent/guardian of the person you are about to register.
Participant Name
*
Title
Mr.
Mrs.
Ms.
Miss.
Mx.
Dr.
Prof.
First Name
Last Name
Parent/Guardian Name
*
First Name
Last Name
Address
Address 1
*
Address 2
City
*
ZIP / Postal Code
*
Mobile
*
Email
*
Age Group
*
16-25
26-35
36-50
51-65
Over 66
Type of Cyclist
*
NON-CYCLISTS (People who have not ridden a bike for several years)
SOCIAL CYCLISTS (People who has been cycling intermittently over the years)
REGULAR CYCLISTS (People who cycle regularly throughout the year)
Preferred Route Option (Provisional)
*
60 miles / 100km
30 miles / 50km
Declaration
Raise Entry Fee
*
£50 of donation to be paid on registration with a minimum balance of £150 donation to be paid prior to the event date. All participants receive a commerative cycle jersey and entrance to celebration event.
Not Liable
*
I understand that the organisers will not be liable for any loss, damage or injury whatsoever directly or indirectly occasioned by or resulting from the negligence, wrongful act, or the fault of the organisers of Friends of Portglenone GAC or any act of God or physical condition of the entrant.
Become Member Cycling Ireland
*
I wish to confirm that Friends of Portglenone GAC have strongly advised that I become a member of Cycling Ireland to avail of their insurance benefits.
You can sign up at:
https://www.cyclingireland.ie/get-involved/membership/
Payment
*
Submit
PG100
Cycle Registration
MINI PG100, 5k & 10k Registration
Useful Information
Donations
Sponsor Sheet
Staff
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