Wiggle Pedal Pendle 24th September 2017 Register Tackling the Pendle countryside you will enjoy one of three routes, 25km, 68km, or 95km. Whichever route you choose you will be able to enjoy the beautiful surroundings as you pass through the district of Pendle REGISTRATION FORM Personal information Group name: If you are walking as part of an organised group please put your group name here. Any medical conditions our team should be aware of? Title: First name: Last name: Address: City: County: Postcode: Email: Date of birth: You need to be at least 12 years of age to take part in the event. Emergency contact name: Emergency contact number: Rider mobile number: Distance: Parent/guardian name: Contact address: Phone: Email: Payment details Pay by Credit/Debit Card Entry fee £ Are you happy for Pennine Events to retain your data? Are you happy for Wiggle to retain your data? Spam protection: 5DVXVVMQJ5GGHC Type or copy & paste the code you see on the left side.