STANDARD ENTRY FORM

For Events Held Under The Rules & Regulations Of TLI Cycling

Event or Series Name: Date(s) of Event(s):

Name: Club/Sponsor:

Full Address:

Phone Number: Email Address:

Date of Birth: Category (see below):

TLI Cycling Membership/Licence Number: Are You Entering As a Day Member? Tick Here:

Emergency Contact & Phone Number:

TLI Cycling Categories

Under 16 - 18 19 - 22 23 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65- 69 70 -74 75 +
Age 16

Category Juvenile Junior Espoir Senior Master Master A B C D E F G H

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TLI Cycling events are organised in age and ability categories. Such categories are determined by the competitors age on
the day of the event. In the case of dispute on age or gender grounds, details will be checked on the competitors birth
certificate. New members usually commence in the category defined by their age but may be reclassified at any time to a
group that most suits their current ability.

ALL COMPETITORS STATEMENT: I confirm that I am not subject to suspension by any other Cycling Organisation, or
that if so the National Executive of TLI Cycling, on appeal, has adjudged the action to be not applicable to TLI Cycling
events. I also understand that failure to disclose a suspension can result in disqualification from TLI Cycling
membership. I agree to adhere to all conditions of TLI Cycling membership.

Signed: Date:

DAY MEMBERS STATEMENT (To be signed by parent/guardian if under 18): I apply to be a day member of TLI Cycling
Ltd. I understand that TLI Cycling is a company limited by guarantee. As a member, my liability will be limited to £1 and
I undertake to contribute £1 to the assets of TLI Cycling in the event that the Company is wound up while I am a
member or within one year after I cease to be a member. Juvenile/Junior Competitors-Disclaimer : I give
permission for my son/daughter/ward to become a day member of TLI Cycling Ltd, and I accept that I shall be held
reponsible for the payment of £1, as detailed above, if the company is wound up.

Signed (To be signed by parent/guardian if under 18 years of age): Date:

JUVENILE/JUNIOR PARTICIPATION DISCLAIMER: I give permission for my son/daughter/ward, to take part in this
event. I understand that he/she, participates at his/her, own risk and without liability whatsoever on the part of the
promoting club it’s officials or members, or members and officials of TLI Cycling, in respect of any injury, loss or
damage suffered by him/her however caused, whether by negligence or otherwise. I confirm that my
son/daughter/ward is sufficiently responsible and experienced to assume full and entire responsibility for his/her own
safety whilst engaged in a competition of this kind on the public highway. Important notice: Juveniles are not allowed
to compete unless a parent/guardian, is present and has signed this disclaimer on behalf of the entrant. Juveniles
under the age of 14 years are not allowed to compete on the public highway unless the event is a Time Trial and then
only if they have attained the age of 12 years.

Signed (To be signed by parent/guardian if under 18 years of age): Date:

Entry Fee Enclosed : ______________________________________

If you require confirmation of entry, please enclose a stamped, self-addressed envelope (minimum A5 size).