By filling in this form I confirm that I have already secured a place in Prudential RideLondon-Surrey 100, directly from the event organisers. Please sign me up to receive fundraising tips and advice and any useful updates about Prudential RideLondon-Surrey 100 by email, mobile messaging and social media. If you do not already have a place, please return to the event page for details on how to apply for one of our charity places in the event. Read the full terms and conditions When you sign up to cycle for Team Now you will receive: A Breast Cancer Now cycling jersey A fundraising pack including sponsorship forms and fundraising ideas To join our team please complete the form below and we'll send you out everything you need. Title * - Select -MrMrsMsMissDrProfessor First name * Last name * Date of birth Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 Address 1 * Address 2 Town * Postcode * Phone number * Email address * What size cycling jersey would you like? * - Select -Cycling small - 38.5"Cycling medium - 40"Cycling large - 41.5"Cycling X Large - 43"Cycling 2X Large - 44.5"Cycling 3X Large - 46"Cycling 4X Large - 47.5" How did you hear about taking part in this event for Breast Cancer Now? * - Select -Google / Search engineWord of mouthEmail from Breast Cancer NowMailing from Breast Cancer NowFacebookTwitterI saw a posterBike ShowRideLondon BallotNewspaper / MagazineBreast Cancer Now websiteOther websiteOther Please give details: Keeping in touch with Breast Cancer Now We’d like to tell you ways you can help further, including through donating, fundraising, campaigning and volunteering and send you updates on our research, breast health information, and our wider work to achieve our aims. If you already hear from us, we will continue to contact you in the same way. If you don’t already hear from us, please tick the box if you are happy to be contacted by: Keeping in touch Email Mobile messaging Do you have a personal experience of breast cancer? If you select information about your health from the drop-down menu, we may use this to provide you with tailored breast health information, volunteering opportunities and to manage how we communicate with you. We may also use this information to better understand our supporters. By selecting the information relating to my health status, I agree to Breast Cancer Now using the information for the above purpose. - None -I currently have breast cancerI used to have/once had breast cancerA member of my family currently has breast cancerA member of my family used to have/once had breast cancerMy friend currently has breast cancerMy friend used to have/once had breast cancerI have lost someone to breast cancerI had a breast cancer scareI have professional experience of breast cancerI have no experience of breast cancerPrefer not to say How we use your information From time to time, we may contact you by telephone and post to keep you updated on our work and ways you can help. You can change the way you hear from us at any time by emailing us at supporterengagement@breastcancernow.org or calling us on 0333 20 70 300. To help us to work more efficiently, we may analyse your information to make sure you receive the most relevant communications, and to target our digital advertising. This may include using publicly available information. You can ask us to stop this at any time, by contacting us using the above contact details. You can read more about how we will use your information in our privacy policy.
