Registration

Rev Up Event Registration 2011

All proceeds to benefit Down Syndrome Ireland.

Your registration pack includes: T-Shirt, Bike Sticker & Sponsorship Form.

You can fill in your details, submit the form directly via the web, or print this page and post the page to:

Rev Up for DSI
Down Syndrome Ireland
Down Syndrome Ireland,
Citylink Business Park
Old Naas Road
Dublin 12

Sponsorship Targets

€1,000.00 - €2,000.00
€2,000.00 - €4,000.00
€4,000.00 - €6,000.00

Rider Details

Pillion Details
Last Name: Last Name:
First Name: (* Required) First Name:
Gender:
Male: Female:
Gender:
Male: Female:
Address: Address:
   
   
Phone: Phone:
Mobile: Mobile:
Bike: Bike:
Email: (* Required) Email:
Roommate:
No Preference: Nominate:
Nominated Name:
By attending and/or participating in the Down Syndrome Ireland Rev Up 2011 event, I agree to indemnify and hold harmless theDown Syndrome Ireland, collectively, or its officers and assistants individually,from all cost, expense, and liability arisingout of my person or property, which may be caused, by any act or failure to act,by the Down Syndrome Ireland Rev Up 2010 event,

its officers or agents arising directly or indirectly from my participation in any event or presence at the event, and I hereby assume liability for any loss, damage or other liability from such events.

By attending and or participating in any event sponsored by Down Syndrome Ireland, I do hereby agree that neither the sponsors,

volunteers nor anyone affiliated with any Down Syndrome Ireland event, will be held responsible for any accidents, thefts, vandalism, or personal injury, or property damage that may occur during any Down Syndrome Ireland event or benefit.

I agree that I will obey the instruction given by Gardai or authorised Rev Up Marshall.s or agents of Down syndrome Ireland, and that I will adhere to the laws and by-laws to ensure that I, my pillion and my vehicle are road-worthy and fully insured.

I agree to all of the above. (* Required)

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Contact Revup4dsi on 01 426 6525 or email aidan@downsyndrome.ie

©2010 Down Syndrome Ireland