Paris Roubaix 2025 Complimentary

Name*
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Address*
Street Address Address Line 2 City County Post Code
Date of Birth*
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We would like to profile your fundraising. This may involve interviews with local media outlets. Are you happy for us to send your story out to the media?*
Please select the size of cycling jersey you would like:*
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Minimum Fundraising*
Can you confirm that you will be able to raise the minimum fundraising agreed?
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