I enclose a cheque/postal order (payable to WheelPower) Please debit my Access/Visa/Switch number: ................................................................................................... Start Date ................................ Security No .............................

Expiry Date ............................. Issue No ................................. Cardholders Name ................................................................... Signed ....................................................................................... Date .............................................

Entry Fee:
Adults 10, Under 16 FREE Entry Fee on the day 20 Each I enclose payment for Entry fee.

6 Tick here if you are a UK tax payer and wish WheelPower to reclaim the tax on your donation (at no cost to you)

Adult 10 (20 on day) .......................................... Additional Donation ..........................................

Car Parking 6 For health and safety reasons parking at the stadium will be restricted for the exclusive use of disabled participants. Tick if disabled parking is required. Conditions I acknowledge that the Mix96 Tour de Vale Bike Ride is a sponsored charity ride and I pledge to raise as much sponsorship as possible. The ride is not a race and all riders must obey the highway code and are advised to wear a helmet. I understand that if I am in doubt about my health or have a medical condition that could be affected by exercise, I should obtain my doctors approval before participating in the Mix96 Tour de Vale Bike Ride. Cycling can be dangerous and I accept that the organisers cannot be held responsible for personal injury, accident, loss or damage caused or sustained as a result of my participation. I agree that I will abide by the rules set out by WheelPower for participating safely in this event. Riders under 16 must be accompanied by an adult. I understand that WheelPower may take photographs of me taking part in this event and permit them to use the images for promotional purposes.

Thousands of men, women and children become disabled due to an accident or illness every year and like many people who are born with a disability, they need to use a wheelchair. WheelPower, the national charity for wheelchair sport provides, promotes and develops opportunities for disabled people to participate in recreational and competitive wheelchair sport. Disabled people are far less likely to be physically active - only 6.1% of people with a disability regularly play sport compared to 16.6% of the general population (Sport Englands active people survey 2009) WheelPower helps increase the number of disabled people leading healthy and active lives increase the number of sporting opportunities for disabled people raise awareness of wheelchair sport build on the legacy of the London 2012 Olympic and Paralympic Games to inspire more disabled people to play sport Sport really has the power to transform lives and has tremendous benefits for people with disabilities: improved health and physical strength; increased self esteem and confidence and improved social opportunities, all of which result in a better quality of life and independence. Please take part in the Mix96 Tour de Vale Bike Ride and help us transform lives through sport.

Vale
Bike Ride

Tour de

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6 WheelPower will contact you by post and email to provide further information about the Tour de Vale Bike Ride. We would also like to email you our newsletter which contains information on our work - if you prefer NOT to receive this please tick this box.

Sunday 9th June 2013 Stoke Mandeville Stadium

Supported by
Supported by and

RETURN WITH YOUR REGISTRATION FEE TO: WheelPower, Stoke Mandeville Stadium, Guttmann Road, Stoke Mandeville, Buckinghamshire, HP21 9PP or enter online at www.tourdevale.com
Charity Reg No. 265498

3 SIGNED ROUTES MARSHALS FIRST AID MECHANICS REFRESHMENT STOPS SUPPORT VEHICLES BARBEQUE

Entry Form
Your entry fee ONLY covers the cost of organising the ride. After we receive this form we will send you a sponsor form.

Mix96 Tour De Vale Bike Ride

Why not make 2013 the year that you take up our challenge of the Tour de Vale Bike Ride? Starting and finishing at Stoke Mandeville Stadium, our three routes will take you through stunning Buckinghamshire countryside and villages, receiving a warm welcome at the refreshment stops along the way. Last year over 1,000 registered riders took part in the ride raising an awesome 28,000 to help disabled people.

How much is it to enter?

Pre-registration costs: Adult Handcyclists On day entry costs 20 for each rider. * Children under 16 must be accompanied by an adult 10 FREE Children under 16* FREE

Choose route: 6 15 Mile 6 35 Mile 6 55 Mile 6 Tick if you will be using a handcycle

PLEASE ask your family and friends to sponsor you generously and help many disabled people. Please complete details in block capitals. One form per adult or child rider. Photocopies are acceptable. CLOSING DATE FOR PRE-REGISTRATION - WEDNESDAY 5TH JUNE Title ........................ First Name ...............................................

Why take part for WheelPower?

Thousands of men, women and children become disabled due to an accident or illness every year and like many people who are born with a disability, they need to use a wheelchair. Based at Stoke Mandeville, the birthplace of the Paralympics, WheelPower helps disabled people play sport and lead healthy, active lives through a range or sports programmes and events.

Do I have to raise Sponsorship?

Yes! The Mix96 Tour de Vale Bike Ride is a sponsored event in support of the charity WheelPower and we ask that all participants try to raise sponsorship. So please ask your family, friends and work colleagues (many companies will match their employees fundraising), your local shop, gym or anyone else you can think of. You can also raise funds securely online at www.wheelpower-raisemoney.org.uk

Surname ................................................................................... Address ..................................................................................... .......................................................... Postcode ........................ Daytime Tel .............................................................................. Evening Tel ............................................................................... e-mail ....................................................................................... Date of Birth ............................................................................. For payment details - see reverse. How did you hear about this event? ....................................... Prizes for best team fancy dress and most sponsorship.

How do I enter?
Complete and return this entry form by post to: WheelPower, Stoke Mandeville Stadium, Guttmann Road, Stoke Mandeville, Bucks, HP21 9PP or tel: 01296 395995 fax: 01296 424171 email: info@wheelpower.org.uk or enter online at www.tourdevale.com

Images courtesy of Michaela Greene