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					                                                                           St. Michael’s Hospice

Annual Sponsored Bike Ride raising funds
                                                                           Big Wheel Bike Ride
for St. Michael’s Hospice (North Hampshire).                                                                                 ENTRY FORM
Registered charity no. 1002856

Sunday 20th July 2008                                                                        Sunday 20th July 2008
An exciting & enjoyable day for all the family                                                         Start time: 9.00am - 10.30am
                                                                                           Starts and finishes: Down Grange Sports
45 miles: start at 9.00am                                                                         Complex, Pack Lane, Basingstoke
24 miles: start at 9.30am                                                                          To qualify for one of the top fundraiser prizes, please
                                                                                                        have your sponsorship forms in by 10th October
<7 miles: start at 10.00am
                                                                                                                    Choice of routes:
                                                                                                                     • < 7 miles
FREE training rides with the North                                                                                   • 24 miles
Hampshire Road Club                                                                                                  • 45 miles
                                                                                                                    Prices:
Delicious refreshments, music, and                                                                                   • Adult        £12.00
massage for those aching limbs!                                                                                      • Children     £6.00
                                                                                                                     • Family       £30.00
                                                                                                                     • Tandem       £20.00
First Aid teams, pick-up support                                                                                    Prizes:
vehicles, clearly signed and                                                                                         1st 6 months single membership
marshalled routes                                                                                                    to Basingstoke Sports Centre
                                                                                                                     2nd Mountain Bike courtesy
                                                                                                                     of Action Bikes £200
                                                                                                                     3rd Sony PS2



                                                                                                                     HOTLINE:
                                                                                                                     01256 848 848
                                                                                                               Email: bigwheel@stmichaelshospice.org.uk
                                                                                                               Website: www.stmichaelshospice.org.uk


                                HOTLINE:
Sponsored by
                                01256                                                                                         Sponsored by


                                848 848
If the event is not for you,
please pass this leaflet on      Email: bigwheel@stmichaelshospice.org.uk
to a keen cyclist. Thank you.   Website: www.stmichaelshospice.org.uk
                                                       starts are staggered between 9:00am - 10:30am.
                                                       Our sponsored annual bike ride is the largest
                                                                                                                                                                                                                                  T-shirts
Services                                                                                                                              Prizes
                                                       event in the Hospice’s calendar. In 2007 1100                                                                                                                              100% pure cotton
                                                                                                                                                                                                                                  (Limited stock may vary in design & colour)
St. Michael’s Hospice provides:                        riders raised £30,000 in profit for the Hospice,                               ● 1st - 6 months single memebrship to
• In-Patient Care • Day Care • Community               so why not come along and help us exceed this.                                                                                                                             Please indicate quantity
                                                                                                                                        Basingstoke Sports Centre                                                                 and sizes:
Nursing Service • Out-Patient Clinics                  Cycling is a perfect way to keep healthy,                                      ● 2nd - Mountain Bike courtesy of Action
An holistic approach is fundamental to the care        de-stress and provide you with more zest for                                     Bikes £200                                                                                Child £6.50
the Hospice offers and Hospice staff work as a         life. If you haven’t been on a bike for a while,                               ● 3rd - Sony PS2                                                                            ● 5-6                 ● 7-8                  ● 9-10                ● 11-12
multi-professional team which includes:                don’t worry as the North Hampshire Road
                                                                                                                                                                                                                                  Adult £9.50
• Nursing and Medical Staff                            Club are on hand to ease you back into the
• Occupational Therapist • Physiotherapist             saddle with free training rides taking place each                              Entry Form                                                                                  ● Sml                 ● Med                  ● Lrg                 ● X-Lrg
• Complementary Therapists • Chaplaincy                Monday evening starting on the 12 th May.                                                                                                                                  Fitted Tee £10.50
• Family Support • Bereavement Support                                                                                                Please use one form per cyclist unless
                                                       All three rides start and finish at the Down                                                                                                                               ● S-M                 ● M-L                  ● XL
This year it costs around £2 million to fund           Grange Sports Complex, Basingstoke where                                       entering as a family residing at the same
St. Michael’s Hospice, 32% comes from the              can enjoy free parking and amazing free                                        address. Photocopies are accepted,                                                          Please add post & packaging at 50p per t-shirt
government, and the remaining £1.3 million             entertainment. This includes fun and games                                     or forms can be downloaded from
must be generated through fundraising                  from the Circus Works team with activities                                     www.stmichaelshospice.org.uk.                                                               I enclose Registration Fee £ . . . . . . . . . . . . .
activities and the Hospice charity shops.              such as plate spinning, juggling and parachute                                 Please note you can register and pay online.                                                Adult £12 , Child (16 and under) £6 ,
                                                       games and the largest Giraffe bouncy castle                                    Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    Family Ticket (2 adults and 2 children) £30,
Here are some examples of current Hospice costs        in Basingstoke, donated by JV Bouncy                                                                                                                                       Tandem £20
which your sponsorship could contibute towards:                                                                                       Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                                                       Castle hire. Riders can enjoy an incredibly
• One day In-Patient Care – £2,300                                                                                                     ..................................................                                         Donation                         £.............
                                                       relaxing free leg massage from our team of
• One week for the team of Community Nurses                                                                                                                                                                                       T-Shirt + P&P                    £.............
                                                       Complementary Therapists. Delicious food and                                    . . . . . . . . . . . . . . . . Postcode . . . . . . . . . . . . . . . . . . . . . . .
    who go out to patients’ homes – £2,000
•   Catering at St. Michael’s Hospice per week         drink to suit everyone is also available.                                      Tel (Day) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .               I am a Tax Payer and wish
    – £391                                                                                                                            Tel (Evening). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .                  to Gift Aid my donation
•   Physiotherapy per day – £70                       Credit/Debit Card Payments                                                      Email . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .   Total Payment                    £.............
•   Occupational Therapy per day – £65
•   A uniform for a St. Michael’s Hospice                                                                                             Name of additional riders in family group                                                   How did you hear about the event?
    Community Nurse – £40                                      Visa                Mastercard           Maestro                       living at the same address.
•   Community transport to take Day Care              Card No.                                                                                                                                                                    .........................................
    patients out for the day – £20-50                                                                                                 Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                                                                                                                                                                  Conditions
•   A litre of base cream to make aromatherapy                                                                                        Relationship to main rider . . . . . . . . . . . . . . . . . . . . . . .                    Riders aged 16 and under must be accompanied by
    oils – £10                                                                                                                                                                                                                    an adult over the age of 18. I understand that this event
                                                      Valid Date                        /                                             Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                                                                                                                                                                  is not a race and all riders must obey the Highway Code
A Fantastic Day Out for                                                                                                               Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .    and the Rules of the Road. Cycling can be a dangerous
                                                      Expiry Date                       /
                                                                                                                                      I have read and agree to the conditions stated below. (To be                                activity and I accept that the organisers cannot be held
all the Family                                                                                                                        signed by parent or guardian if rider is aged 16 or under).                                 responsible for personal injury, accident, loss, damage
                                                      Issue No                         3 Digit Security No                                                                                                                        or public liability. I have read and agree to the above
Why not lend your support by spending                 (Only found on Maestro Cards).                                                  Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                                                                                                                                                                  conditions. I am happy for any photos of me at the
a glorious summer’s day riding through the            Please debit my card to the value of £                                          Relationship to main rider . . . . . . . . . . . . . . . . . . . . . . .                    event to be used for promotional purposes of the event.
beautiful countryside of North Hampshire to                                                                                           Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
raise much needed funds for your local Hospice.                                                                                                                                                                                   Signature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
We invite you to join us on Sunday 20th July for
                                                       Signature                                         Date
                                                                                                                                      Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
                                                                                                                                                                                                                                  Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Big Wheel 14 sponsored by Alberto-Culver and
                                                      The event entry fee goes towards the cost of staging Big Wheel 14 so we         Route                                                                                       Please complete and return with payment to
enjoy one of our three breathtaking routes of                                                                                                                                                                                     St. Michael’s Hospice (cheques made payable
                                                      encourage you to get sponsored. A fantastic prize is available to each of the   Please indicate intended route by ticking box below
<7 miles, 24 miles and a truly testing 45 miles       top three fundraisers so please ask friends, family, work colleagues (many                                                                                                  to St. Michael’s Hospice)
(designed for regular cyclists or those undertaking   companies match employees fundraising), and your local gym, because every        ● Short < 7 miles ● Medium 24 miles
                                                                                                                                                                                                                                  Big Wheel 14, St. Michael’s Hospice, Basil de Ferranti
 training). Each route has refreshment stops and      penny raised really does make a difference.                                      ● Long 45 miles                                                                            House, Aldermaston Road, Basingstoke RG24 9NB


Hotline:    01256 848 848                         E-mail: bigwheel@stmichaelshospice.org.uk                                            Please note you can register and pay online
                                                                                                                                       www.stmichaelshospice.org.uk

				
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posted:3/15/2010
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Description: Big Wheel Bike Ride