Register

To register for Cycle the Wight and receive your sponsorship forms please complete the form below.

After completing this registration form please send your £5 registration fee to:

Cycle the Wight, Earl Mountbatten Hospice, Halbery Lane, Newport, PO30 2ER.
Cheques should be made payable to ‘EMH’.

You can also pay by Debit/Credit Card over the phone on (01983) 528989.

Full Name:
Address:
Postcode:
Date of Birth:
Email Address:
Telephone Number:
Mobile:
Emergency Contact and Phone No:

For under 18s: I have Parent/Guardian Consent
I have read the safety, terms and conditions page