Entry form Foulness Island Bike Ride Sunday September 13 2009 by sdfsb346f


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									Bosom Pals Appeal                                                                            Entry form
Breast cancer is the most common cancer in women in the UK.                           Foulness Island Bike Ride
One in nine women will develop breast cancer at some point in
their lifetime and men can get breast cancer too: around 300
men in the UK are diagnosed every year.
                                                                             Sunday September 13th 2009
                                                                  Rotary Club of Thorpe Bay in partnership with MoD
But there is hope for the future. Treatment for breast cancer
has seen great improvements in recent years, with more            We are delighted to welcome you to this year’s bike ride and are sure
patients living longer. Much of this success is due to earlier    you will join us in thanking the MOD, the Parish Council and Residents
diagnosis and improved screening.                                 of Foulness Island, and the Residents of Great Wakering for making it
We want to give patients the best possible chance of surviving
breast cancer. That's why Southend Hospital Charitable            To join the ride:
Foundation is joining forces with Bosom Pals patient support      1. Enter full details overleaf of all those wishing to ride including
group to buy two new digital mammography machines and                children in seats and trailers. All riders under 16 must be
associated computer equipment for the women of South Essex.          accompanied by an adult.
Having the new screening equipment will allow Southend            2. If you wish to ride with friends please submit all entry forms
University Hospital to share expertise, for radiologists to          together so that we can ensure the same starting times.
provide second opinions and improve cancer detection rates.       3. Attach a cheque or postal order for the entry fee made payable to:
                                                                           The Rotary Club of Thorpe Bay Charity Account
Lead clinician and breast surgeon Mr Neil Rothnie explains:
“The new digital equipment uses improved technology which         4. Send the completed form and a stamped addressed envelope
                                                                     9 inches x 6½ inches to :
provides shorter examination times, better technique and
image quality. Having this at Southend will help us improve the      Foulness Bike Ride, PO Box 2087, Leigh-on-Sea, SS9 5WG
detection of early and small cancers and provide local people
with one of the best breast care services in Europe.”             We will send you full details, confirmation of your starting time, and a
                                                                  sponsorship form for each rider.
The appeal will also fund improvements to the Breast Unit at
Southend University Hospital, including enhancements to the       If you have any questions please leave a message on our telephone
patient environment and state-of-the-art diagnostic equipment.    answering service: 01702 525514. We will get back to you as soon
                                                                  as we can.
And we need your support to raise £750,000 towards this           Additional entry forms and sponsorship forms can be downloaded from
ambitious project. You can help wives, mothers, sisters,          our web site www.thorpebayrotaryclub.org.uk but we regret that entries
daughters, nieces and friends - by taking part in the Foulness    cannot be submitted electronically.
Bike Ride.
                                                                                       Closing date August 31st
Each rider over 16 must sign their entry to indicate that they have read and agreed the following:

By submitting this entry I accept that cycling can be strenuous and dangerous.
I accept that the organisers cannot be held responsible for personal injury, accident, loss, damage or public liability

Name (Please print)               Address (Please print)                    Post code      Age*      Contact              Signature            Ridden before
                                                                                                     Tel. no                                   (Y / N)

* if less than 16

Preferred start time:
No preference      9.30 – 10.00      10.00 – 10.30     10.30 – 11.00    11.00 – 11.30      11.30 – 12.00     12.00 – 12.30    12.30 – 13.00 13.00 – 13.30**

Fee payable:                                                                                                                  **Note:
Adults                Children (under 16)            Family (2 adults & 2                   Total enclosed                    If you plan to do the full 23
„10                   „5                             children) „25                                                            miles this leaves limited time.

 If you do not wish to receive further information from the department of fundraising at                   Rotary use only:
 Southend University Hospital please tick here:
 If you do not wish to receive further information from Thorpe Bay Rotary Club about future
 events please tick here:

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