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Derny Derby

Region 5 East and North Midlands

Date 24-FEB-2018
£25 +service fee
1
ACCOUNT DETAILS
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2
ENTRY DETAILS
If you know how you want to be partnered with, choose 'create or join team' and set up a 'team' for the pair of you (they must enter themselves and join your team, or you enter and join their team). If you don't have a partner, choose 'don't join a team' and we will allocate you a partner on the day
(max team size: 2)
* Address 1
e.g. 99 Stanley Terrace
Address 2
* Town/City
* Postcode
Telephone
e.g. 0208 123 4567
Gender
Male
Female
Date of birth
e.g. 21-Sep-1961
* Do you have any medical conditions
* Emergency Telephone
Contact telephone number in case of emergency e.g. 0208 123 4567
* I am accredited by an indoor UK track
Riders need to be accredited by any indoor UK track to qualify