The

CYCLECHALLENGE

Irish Hospice Foundation

The Wild MediTerranean Way

Join us for the challenge of a lifetimeby cycling from Canet-en-Roussillon, Franceto Barcelona, Spain along the beautifulcoastline and via the spectacular Pyrenees.

Saturday 18th to Friday 24th June 2016

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THE IRISH HOSPICE FOUNDATIONCYCLE CHALLENGE 2016enlist the help of two wheels and join The irish hospice

Foundation (ihF) for the challenge of a lifetime and take

on our 2016 Wild Mediterranean Way Cycle Challenge.

Travel from Canet-en-Roussillon to Barcelonaalong the Mediterranean coast while taking in allthat The Med has to offer. The cycle route startsin Southern France and moves through Roussillonand further on to the foothills of the Pyreneesand beyond to the Catalan Capital Barcelona!

Cyclists of all levels welcome

We welcome cyclists of all levels on our trip anddo this by offering two routes on many days, sothe advanced cyclist can tackle some extraclimbs in Baixa Garrotxa and Montenegre whileothers can continue on with the challenge.

Trip Summary

Departing from Dublin on Saturday 18th June, wetravel to our hotel in Canet-Plage. The followingmorning we will begin the first of five days cyclingthrough the picturesque towns and villages,before spending our first night in Roses – atown rich in Greek and Roman history.Following on from here we head inlandtowards the Pyrenees through the BaixaGarrotxa volcanic zone! We exit the BaixaGarrotxa toward the optional climb of SantHilari Sacalm and move down thecoastline toward Calella with its 3 blueflag beaches where we’ll be spendingthe night. Our last day sees us ridingthrough the Parc Natural deMontenegre before reaching thecoast again and riding along thefamous 4km Barcelona Beach.

The Challenge

You will be cycling over 600km (incl. climbs) or540km (ex. climbs) over the five days, while raisingvital funds for The Irish Hospice Foundation.

There will be options along the way so that thosewho are keen and capable cyclists can tackle theColl Formic and take on the Sant Hilari Sacalm,before we arrive into our final destination – theCapital of Catalunya, Barcelona.

a bit about Cycling Safaris

We enlist the help of the fantastic team atCycling Safaris to plan our route and manageall aspects of our cycle for the entire durationof the trip.

Cycling Safaris have been organising bike toursin the west coast of Ireland since 1989.Since then they have expanded their cyclingholidays to cover the length and breadth ofIreland as well as numerous locations allover Europe. The Irish Hospice Foundationhas been working with Cycling Safarisfrom the beginning of our annual cyclingchallenges back in 2009. This cyclewill be our 11th adventure with themand we are delighted to have them onthe team again!

ITINERARY

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We set off from dublinairport for our morningflight to Girona. On arrival,we will be collected andtransferred by coach toour hotel in Canet-en-Roussillon. You will bereunited with your bike at the hotel as all bikes will havebeen shipped from Dublin by Cycling Safaris. You’ll takein the long sandy beaches here which have a lovelyatmosphere provided by the backdrop of the Pyrenees.There are also plenty of shops, bars and restaurantskeeping this town buzzing.

The first day of cyclingbegins with a nice gentlewarm up along the coastline for 15km to thebeautiful town of Collioure.From here we head inlandand climb for almost10km on a small quiet road that affords wonderful viewsof the surrounding countryside and the ocean. We thenrejoin the coast road and cross the border into Spain.This is a stunning ride with many great vantage pointsas the road twists and turns and rises and fallsfollowing the coastline. The Cap de Creus peninsulaprovides some further undulating territory with someunspoilt scenery together with Cadaques, longassociated with painter Salvador Dali. Roses is ourdestination for tonight which has a rich Greek andRoman history, but today it’s a modern town attractingvisitors for its beaches and restaurants.

The second morning sees us leaving the coast as wehead inland towards the Pyrenees. As we pass the townof Figueres the road offers a great surface and very littletraffic as it gently climbs passing medieval towns andvillages. The wonderful medieval town of Besalu with its12th Century Romanesque bridge and arcaded streets isa perfect stopping point for lunch. The route then leadsus into the Baixa Garrotxa Volcanic Zone! There around30 “cones” from extinct volcanos reside and are hometo unique flora and fauna. Olot is a town of intimatesquares, elegant shops and welcoming bars in the heartof the volcanic zone.

DUBLIN TO CANET-EN-ROUSSILLON

DAY 1SAT JUNE 18

CANET-EN-ROUSSILLONTO ROSES 107KM

DAY 2SUN JUNE 19

ROSES TO OLOT 110KMDAY 3MON JUNE 20

The coast road from Sant Feliuagain offers wonderful riding as itexhibits great views at every cornerand is a particularly unspoilt sectionof coastline. We then head inlandinto the Parc Natural de Montnegre(Black Mountain) to escape someof the busier coastal resorts. Another optional climb here is theSant Hilari Sacalm, which is almost 21km long but a veryreasonable average of 3.2%. Soon we come back down to thecoast and our destination Calella with its 3 blue flag beachesawaits.

Our last day sees us venture inlandagain to the Parc Natural deMontnegre to avoid the busy coastalroad. Here we offer another optionalclimb with the Coll Formic that goesinto the heart of the MontsenyNational Park, a UNESCO biospherereserve (22km long, 920m Gain,4% average). Our entry into Barcelona follows a great riversidebike path for several kms before heading along the coast andpassing the famous 4km beach to reach our finish! We no doubtwill dip our toes in the cooling Mediterranean sea as wecelebrate how we conquered the Wild Mediterranean Way!

After a wonderful celebratoryevening the night before you willhave time to explore the city ofBarcelona before we make ourshort transfer to Barcelona El PrattAirport for our return flight toDublin. *Flight details to follow.

After an initial short climb out ofthe town, we enjoy the most tranquilday of our trip with a long descentacross the Baixa Garrotxa. SantaPau, an atmospheric medievalvillage in the heart of this regionwill make for a worthwhile shortbreak. We then skirt the edge of Lake Banyoles, the largestnatural lake in Catalan with a magnificent backdrop of themountains. The Gavarres massif offers a lovely quiet road andsome extra climbing opportunities for those who want them (suchas the Sant Marti de Romanya or Coll de la Ganga). Soon thecoast comes back into view and our destination Sant Feliu deGuixols can be spotted. It has a beautiful sandy beach backed bya glorious tree lined avenue leading from the rocky headland tothe south. The traffic free Rambla Vidal is a great place to shop,eat and people watch.

SANT FELIU TO CALELLA103KM

DAY 5WED JUNE 22

OLOT TO SANT FELIU DEGUIXOLS 119KM

DAY 4TUE JUNE 21

CALELLA TO BARCELONA 102KM

DAY 6THU JUNE 23

BARCELONA TO DUBLIN DAY 7FRI JUNE 24

inFOrMaTiOn WeeKendAn Information Weekend will take place in May2016, and is an opportunity to meet the IHF andCycling Safaris team as well as other participants. We can answer any queries you may have, give youadvice on equipment and training and give youadditional information about the trip. We will alsohave a modest cycle on this day. This is a reallyuseful day to pick up tips and advice on the route,training and your fundraising. We strongly encourageyou to come to the Information Weekend as itprovides an important and valuable opportunity todiscuss all matters of the cycle. This is a greatchance to get well acquainted with everyone involvedin the cycle and an opportunity to gauge your fitnesslevels! All presentations from the day will be madeavailable to everyone after the weekend, however thisdoes not replace the value of being there in person.

Pre TriP BrieFinGA detailed pre trip briefing will be sent out toparticipant’s approximately one month beforedeparture with all the necessary details includingtravel arrangements.

HOW DO I SIGN UP?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 byFriday 18th March 2016. (An additional cost may occur after this date due to the fluctuation of flight& accommodation costs)

discounted rates:

introduce a Friend orSign up as a Team!Avail of our sponsorship discount* byreferring a friend or by signing up as ateam of 4 or more. Your sponsorship total will be reduced by €250.

* This discount offer is only available toparticipants who introduce a friend who hasnever participated in the Kingspan IHF CyclingChallenge or Teams of 4 or more (this caninclude previous participants) who sign-uptogether.

The total participation fee of €2,990 is splitinto two elements:n Tour cost of €1,050.

n Sponsorship of €1,940.

The tour cost of €1,050 must be paid asfollows:n Registration fee of €250 on sign-up.

n Balance of €800 due 21 days afterreceipt of registration fee.

*note tour cost of €1,050 can only beguaranteed 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 May2016.

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“I hope you will join this wonderful trip thatraises important funds for such a worthycause. I look forward to seeing old friends andmaking new ones as we travel across Franceand Spain”. Paul Kimmage

Journalist & former professional cyclist

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Reaching every county in Ireland, we arebringing hospice care and principles to adults,children and families where and when they areneeded. We receive NO core state funding andrely upon voluntary funds – like those raisedthrough this cycle challenge – to maintain ourwork.

Once again, the money raised through thecycle challenge will help our Nurses For NightCare service – which provides free night-timenursing care in the home for those at end oflife. The nurse stays in the home through thenight providing nursing care, practical supportand reassurance to the person with a lifelimiting condition and valuable respite forfamily members.

2016 marks the 10th anniversary of Nursesfor Night Care and over the last decade theservice has experienced huge growth. When itbegan in 2006 we provided around 100 nightsof nursing care. In 2015 this increased to over1,500 nights of care and we expect this figureto rise again in 2016.

A survey carried out by the IHF in 2014revealed that 74% of people want to die athome, but only 26% get to do so. With your

help we are trying to support more people tospend their final days at home in their ownbed, with their family by their side.

Cyclists who have raised funds over the yearshave played a major role in making this areality. We hope that you will continue to be afundamental part of the funding for this vitalservice by signing up to participate in our WildMediterranean Way Cycle Challenge. Each dayspent in the saddle will mean at least onenight of comfort and nursing care for thosenearing the end of life. The minimum amountraised by each cyclist (after costs) equates to6 nights of care. One week really does a makea difference to those at a very vulnerable timeof 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 providedaround 100 nights of nursing care. in 2015 this increased to over 1,500nights of care and we expect thisfigure to rise again in 2016.

Find out the difference you can make in oneweek…

The irish hospice Foundation (ihF) is a national charity striving for the bestcare at end of life.

if you want to move quickly and guarantee aplace, this Quick Facts page contains all ofthe essential info that you will need to knowbefore signing up.

foothills and not seek out any great climbs.However for the more experienced cyclistsand those looking for a greater challengeyou can tackle some hillier terrain. It has tobe recognised that strong legs and a goodcardiovascular fitness are essential - youwill be in the saddle for approximately 6hours a day. We can provide you with thefollowing support to help you train:

• Professionally prepared training guide• An information weekend that includes a

question and answer session with eventstaff.

• A list of regular open cycling events tohelp with your training.

Self motivation is essential!

n SUPPORT TEAMA support team of several staff andvehicles will organise the ride and beresponsible 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 roomsin 3H or 4H hotels. Please indicateanyone that you would like to share aroom with on your registration form.Single rooms are available for anadditional fee. If you choose to stay onfor the weekend in Spain, you will beresponsible for organising your ownaccommodation and flights.

• Water/snack stops. At least 2 stops (onein 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 forcyclists. However if you have particularsnacks you eat whilst cycling werecommend you bring them along foryourself.

• Lunch. Lunch stops are organised to takeplace in Cafes/pubs, consisting ofsandwiches/baguettes. As we arestopping in small villages for only brieflunch stops it is not practical to have ahot meal at the lunch stops. Lunch is notprovided on day 7.

• Dinner. On days 1, 2, 3, 4, 5, 6 dinnerwill be provided to the group either ina local restaurant or in the hotels. Onday 7 participants are responsible forbuying their own dinner.

• Special dietary requirements. We areonly able to accommodate foodallergies, specific diets i.e. vegetarian,vegan, and/or religious or medicaldietary requirements. Personalpreferences cannot beaccommodated. Please remember tofill them in on the medicalquestionnaire that you receive onceyou have registered. If any individualhas particular snack preferences theyshould consider bringing a quantitywith them on the trip.

n TRANSPORT• Flight to Girona on the 18th June and

return flight from Barcelona on the24th June. For those staying on forextra nights you must make your ownreturn flight arrangements.

n WEATHERCycling at this time of year is usuallypleasant and sunny, but you shouldcome prepared for all weathers. Ensureyou have packed a waterproof cyclingtop and sunscreen.

n BIKE INFORMATIONYou will need to bring your own bike toCycling Safaris in Dublin approximately 1week in advance of the trip for it to betransported to France. Please ensurethat it has been recently serviced. We willarrange for your bike to be transportedsafely back to Ireland where it will beavailable for collection from CyclingSafaris in Dublin.

n WHAT IS NOT INCLUDED?• Travel insurance – mandatory – you

must provide us with evidence of yourcover. Note: You will not be allowedparticipate in the trip without Travelinsurance.

• Bike insurance• Personal spending money• Lunch and dinner on day 7

QUICKFACTS

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n SECURING YOUR PLACETo 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 usingthe form enclosed.

• No travel arrangements will be madeuntil the full Tour Cost of €1,050 is paid.

Registrations taken after the 18th March2016 may incur extra costs. This will bemade clear to participants in advance ofregistration.

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 theapplication form and registration fee tosecure your place on the trip.

N.B. No travel arrangements will be madefor you until the balance of the tour cost ispaid.

n Deadline 3: 1st May 2016. You mustraise and pay €975 by this date.

n Deadline 4: 31st May 2016. By thisdate you must have raised and paid afurther €965, bringing your totalParticipation Fee €2,990, otherwise youjeopardise your place on the trip.

n FUNDRAISING SUPPORTThe team of professional fundraisers at theIHF will provide you with fundraisingsupport including: • Access to fundraising materials and IHF

merchandise.• An online sponsorship account - friends,

family and colleagues can sponsor youonline through your own personalisedweb page on www.mycharity.ie orwww.idonate.ie

• A direct phone number and emailaddress for an IHF fundraiser.

n TRAINING SUPPORTThis cycle crosses the naturally undulatingterrain of France and Spain. Although nota flat route we will stick mostly to the

www.hospicefoundation.ie @irishhospice irish hospice Foundation

1. Anyone taking part in this event are acting as volunteersfor The Irish Hospice Foundation and are responsible forand obtaining all necessary permits and permissions inrespect of public collections.

GENERAL

2. The Irish Hospice Foundation has appointed Irish CyclingSafaris Ltd (The Company) to organise transport,accommodation, first aid and guides for The IrishHospice Foundation Cycle Challenge (“the Event”) andaccepts no liability for any loss or damages howsoeverarising or for cancellation of the Event for any reason.

3. The Irish Hospice Foundation has no control over theorganisation and running of the Event and allparticipants take part at their own risk.

4. The Irish Hospice Foundation has no control over whathappens on the Event from the time it departs fromDublin to the time of its return to Dublin. The IrishHospice Foundation is, therefore, under no liability incontract, negligence, or otherwise for any matteroccurring during those dates or for any loss or damagesustained by any participant during those dates. Anycomplaint must be notified directly to the Irish CyclingSafaris Ltd within 14 days of the end of the Event, inaccordance with Irish Cycling Safaris Ltd BookingConditions below.

REGISTRATION FEES AND DONATIONS

5. To secure your place you will need to: Fill in and returnthe enclosed registration form by 18th March 2016along with your €250 non-refundable registration fee.You will need to pay the balance of Tour Cost, €800, 21days after receipt of the application form andregistration fee to secure your place on the trip. N.B.No travel arrangements will be made for you untilthe balance of the tour cost is paid. Before 1st May2016 you must have raised and paid €975 of yourSponsorship balance. By31st May 2016 you must haveraised and paid a further €965 bringing your totalParticipation Fee to €2,990, otherwise you jeopardiseyour place on the trip.

6. If you are unable to obtain the minimum target amountof sponsorship (€1,940) you are liable to forfeit yourplace on the Event and your non-refundable registrationfee of €250; donations will only be refunded directly tothe donor, upon written request by the donor.

7. You must make it clear to all your prospective sponsorsthat €1,050 of the €2,990 comprises the cost ofregistration 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 theEvent, donations and registration fees will not berefundable to you; donations will only be refundeddirectly to the donor, upon written request by the donor.

10. All funds raised in the name of The Irish HospiceFoundation in connection with the Event must be paid assoon as practicable to the Irish Hospice Foundation [inaccordance with the method of payment provisions inthe 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 BOOKINGCONDITIONS

15. Irish Cycling Safaris LTD (The Company) acceptsbookings subject to the following conditions:

n Passports, VisasClients are responsible for arranging, and must be inpossession of a valid passport and any visa requiredfor the whole of their journey. Information aboutthese matters or related items (climate, clothing,baggage, personal gear etc) is given in good faith butwithout responsibility on the Company. Clients with aEuropean passport will not need a visa and it is theresponsibility of any other passport holders to checkwith their embassy.n Insurance &Cancellation InsuranceTravel insurance is mandatory for all clients whilst ona tour organised by the Company. Clients togetherwith their personal property including baggage are atall times solely at their own risk. Clients are whollyresponsible for arranging their own insurance. Clientsare responsible for ensuring that they are inpossession of private Travel Insurance with protectionfor the full duration of the tour in respect of at leastmedical expenses, injury, death, repatriation,cancellation and curtailment, with adequate cover.Clients should ensure that there are no exclusionclauses limiting protection for the type of activitiesincluded in their tour. Clients should satisfythemselves that any travel insurance arrangedthrough the Company is what they require andshould arrange supplementary insurance if need be.Clients will be deemed to have read the insurancecover.n ItineraryWhile we endeavour to follow our itinerary there maybe exceptional circumstances when this is notpossible.We reserve the right to cancel or modify theitinerary as necessary. Due to the nature of the tripsarrangements have to be planned well in advance, sochanges may have to be made and the Companyreserves the right to do this. Should a material changebe necessary the Company will inform you as soon asreasonably possible. A material change includes, forexample, a significant change of destination or routetime by more than 12 hours.n Medical FormPrior to the event you will be asked to complete amedical questionnaire. If you are over 60 years of ageor if you have any medical condition that could beadversely affected by exercise, particularly a heartcondition or asthma, you must provide the Companywith a medical certificate from your doctor. Bysigning this form you are confirming that, to the bestof your knowledge, your general state of health isgood and that you take full responsibility for yourhealth and personal well being. All medical forms willbe independently reviewed by a doctor prior todeparture.n Minimum AgeParticipants must be over the age of 18 on the day ofdeparture. The Company reserves the right to refuseparticipation to anyone at any time without having todisclose the reason.n Challenge ParticipationWe accept your booking on the understanding thatyou realise the hazards involved in this type of tour,including injury or death, disease, loss or damage toproperty, and that you come on the tour at your ownrisk. We accept no liability for any injury resultingfrom the hazards of cycling or any other activityincluded in the itinerary, or for any other mishaps to

yourself or your property, and in particular as aconsequence of strikes, wars, riots, sickness or othersuch happenings. Any independent travelarrangements that you make are also at your ownrisk. While on the cycle, illegal behaviour or conductconsidered unsuitable will not be tolerated and couldresult in the participant being asked to leave the cyclewith no refund. The decision to participate in thecycle or parts therein lies with each individual. n EquipmentClients taking their own equipment on tour areresponsible for any charges for transportation leviedby the transport provider including excess baggage.You must wear a helmet on this trip. Clients areresponsible for ensuring that their bike is in a suitablecondition for participation in a cycle of this nature.The company will endeavour to accommodateclients, but cannot guarantee that correct tools andspares will be available. Clients will be expected topay for any spares they require during the trip.n If you have a complaintShould you have a complaint about any of the tourarrangements, you must tell both the relevantsupplier and the Company’s representative whilst onthe trip or within 14 days of the end of the Event. It isonly if the Company and the relevant supplier knowabout problems that there will be the opportunity toput things right.n DelaysThe timings of road, ferry or flight departures areestimates only. We cannot accept liability for anydelay in your travel arrangements from or to Irelandwhether the cancellation or delay is caused byadverse weather conditions, rescheduling by atransport provider, port authority, mechanicalbreakdown or industrial action. Where long delaysresult in lost challenge time, no refunds are given byhotels or suppliers. Similarly, transport providers donot offer compensation for delays. It is in recognitionof the above that the Company’s travel insurancepolicy offers some monetary compensation fordelays over 12 hours to cover lost time or delayedreturn.This Event is conceived and operated by IrishCycling Safaris Ltd.[Ground arrangements are fully insured throughIrishCycling Safaris Ltd.]Irish Cycling Safaris Ltd, Belfield Bike Shop,UCDBelfield, D-4

WAIVER

16. Participants hereby acknowledge that they take partin the Event and all functions and events relatedthereto at their own risk. Participants hereby agreefor themselves, their executors, administrators,heirs, next-of-kin, successors and assigns to waiverelease and discharge and to neither have norinstitute any claims whatsoever against The IrishHospice Foundation or Irish Cycling Safaris Limited.This waiver covers death, disability, personal injury,damage to and loss of property of a participant andis effective whether or not such death, injury,damage or loss may have been caused directly orindirectly or wholly or partly by any act or omissionincluding negligence, of The Irish HospiceFoundation or Irish Cycling Safaris Limited or theirrespective servants, agents and contractors and willbind the heirs, executors and/or trustees of theestate of a participant.

17. We are delighted that Paul Kimmage is supportingus. We cannot however guarantee his participation.

The Kingspan IHF Cycle Challenge Canet-en-Roussillon to Barcelona rules and regulations

TERMS AND CONDITIONS

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The HI F

FORMRegistration

SAT 18 - FRI 24JUNE 2016

PERSONAL DETAILS

Title ________________________________________________

Name(s) ________________________________________________

Surname ________________________________________________

Address ________________________________________________

________________________________________________

________________________________________________

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 ________________________________________________

________________________________________________

________________________________________________

Relationship ________________________________________________

Phone (day) ________________________________________________

Phone (mob) ________________________________________________

PASSPORT DETAILS

NB: Passport must be valid for 6 months after date of travel

Name (as on passport) _________________________________________

Passport Number _________________________________________

Expiry Date _________________________________________

Place of Issue _________________________________________

Date of Issue _________________________________________

Nationality _________________________________________

Country of Residence _________________________________________

INSURANCE

Do You have travel insurance* Yes 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 tourin respect of at least medical expenses, injury, death, repatriation, cancellation andcurtailment, with adequate cover.

Are you a smoker? Yes No

IHF Official Cycle Challenge 2016 Cycling Jersey. Please see size chart and tick size req.

Cycle Jersey Size S M L XL XXL 3XL 4XL

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 forbooking your own accommodation for the extra nights and your return flighthome. We will be happy to provide you with the name and details of the hotelin Spain.

I have read and agree to abide by the Rules and Regulations in theaccompanying event brochure which I understand may change from time totime 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: _____________

PAYMENT DETAILS

I enclose a cheque for the amount of €250 made payable to the IrishHospice Foundation Please charge €250 to my (Tick as appropriate) VISA MASTERCARD LASER

Credit Card Number

________________________________________________________________

Exp Date CVV No

________________________________________________________________

Name on Card

________________________________________________________________

Address Of Cardholder

________________________________________________________________

________________________________________________________________

Participation in the cycle is at the sole discretion of The Irish Hospice FoundationPlease return your completed application form plus deposit to:Ruairi McGinley, Irish Hospice Foundation, 32 Nassau St, Dublin 2, IrelandRuairi is contactable at 01 679 3188 or ruairi.mcginley@hospicefoundation.ie

www.hospicefoundation.ie@IrishHospiceIrish Hospice Foundation

JERSEY SIZE CHART S M L XL XXL 3XL 4XL

HEIGHT cm 172 – 176 175 – 179 178 -182 181 – 185 184 – 188 187 -191 190 – 193CHEST cm 92 -96 96 – 100 100 -104 104 -108 108 -112 112 – 116 116 -120

Do you have any special dietary requirements? Yes NoIf 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.

PLEASE NOTE: All accommodation will be sharedDo 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

CYCLECHALLENGE

CHY: 6830

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