First Name *
Email Address *
United StatesCanadaUnited KingdomAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic People's RepublicCongo, Republic ofCook IslandsCosta RicaCote d'IvoireCroatia/HrvatskaCubaCyprus IslandCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEquatorial GuineaEl SalvadorEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGreeceGhanaGibraltarGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly See (City Vatican State)HondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldova, Republic ofMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandPolandPortugalPuerto RicoQatarReunion IslandRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovak RepublicSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaTogoTokelauTongaThailandTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands (British)Virgin Islands (USA)Wallis and Futuna IslandsWestern SaharaWestern SamoaYemenYugoslaviaZambiaZimbabwe
Address 1 *
Zip / Postal Code *
Please read the following before clicking "agree to terms".
1) You agree to fundraise a minimum of £325 per participant (excluding your registration fee and gift aid).
2) If you withdraw from the event you must notify Retina UK at the earliest opportunity. If this occurs you agree to pay any costs incurred by the charity. Your deposit will not be refunded and any money raised will be retained as a donation.
3) You agree to raise the full balance of the fundraising target in accordance with the deadlines or make up the balance.
4) All money raised must be paid to Retina UK, registered charity no. 1153851. You can send all sponsorship money to our Buckingham office clearly identified as sponsorship for your participation OR submit monies through an online fundraising platform.
5) You will inform us of any public event that you arrange and when collecting money will comply with all relevant by-laws, regulations and legislation and will co operate fully with the charity. You will provide information on request and in good faith.
6) You will keep address or electronic contact details of all your sponsors (we may ask for these details) and thank them appropriately.
7) You will keep all moneys raised on behalf of the charity safe and separate from any other funds and submit all monies as early as possible.
8) You will not reproduce the Retina UK logo without permission.
9) Any material you are authorised to produce must include our registered charity number (1153851)
10) You understand that you have no authority to enter into any commitment or liability on behalf of or in the name of the Charity.
11) You are solely responsible for any charges, taxes or other duties that may be levied against your fundraising.
12) You will not raise funds by carrying out house to house collections.
13) We reserve the right to withdraw your place.
14) You will not do anything to bring the name of Retina UK into disrepute.
15) You take part in the event at your own risk. We do not accept any liability for any loss or damage, however arising, including from cancellation of the event.
16) Persons under the age of 16 must be partnered by a parent or legal guardian
Your Responsibility - Personal Insurance.
It is recommended that you take out your own insurance to cover illness, injury, personal belongings (including your bicycle if you use your own for the challenge) and cancellation - cancellation fees are implemented in all cases, so we recommend that you are fully covered by a travel insurance policy to cover non-returnable costs should you have to cancel your trip due to unexpected circumstances.
Retina UK’s Responsibility.
We hold public liability insurance for this event.
We will not carry insurance or any liability for loss or damage to your bicycle or other personal possessions during the challenge.
+44 (0)1280 821334
+44 (0)845 123 2354
Retina UK, Wharf House, Stratford Road, Buckingham, MK18 1TD
Registered Charity No. 1153851
© Copyright Retina UK
Site Design by B1 Creative