London to Bruges Cycle : 06/09/2025 - 09/09/2025

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Personal Details

Please can you tick the box if you have been on a trip with us before

Title:

First Name *:

As it appears in your passport

Last name *:

As it appears in your passport

Gender *:

Shared accommodation is standard. We may contact you privately to discuss your room share options. Please use the Room Share Request field in the portal if required.

Gender description:

Date of birth *:

dd/mm/yyyy (under 18?)

Postcode *:

Address Line 1 *:

Address Line 2:

Address Line 3:

Town/City *:

County:

Country *:

State:

Mobile Phone *:

Home Phone:

Work Phone:

E-mail Address *:

Please re-type E-mail Address *:

Team name:

If you are participating in the challenge as part of a team please enter the team name here

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Where did you hear about this Challenge? *:

Please give more detail where possible:

Why have you chosen to fundraise for The Brain Tumour Charity? How did you hear about us? *:

What size charity t-shirt would you like us to send you for this event? Our unisex t-shirts/ cycling jerseys come in sizes S to XXL (please note, we will send this to the address you used to sign up to the event). *:

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By clicking Next you agree to Discover Adventure Ltd contacting you about this challenge.