Cycling Lesson - Everything Outdoor NE

Guwahati Cyclothon - Everything Outdoor NE
Name of the participant*

First NameLast Name
Name of the guardian
If the participant is a minor (under 18)
Phone Number

Area CodePhone Number
Mobile Number*
10 digit mobile number
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Emergency Contact*
Person we can contact on emergency
Blood Group*
Your blood group
Are you under any prescribed medication?*
Mention the names of medicines you are taking at present
Any severe injuries in the past?*
If yes, describe about your injury
Do you have a cycle?*

NoYes, ownYes, rented
Paid the registration fee using*

PaytmICICI BankSBI BankNot Paid
If paid via bank, transaction number below
If paid via Paytm, mobile number below
The information in this form filled up by me/my guardian is true and complete to the best of my/our knowledge.
Should be Empty:

Guwahati Cyclothon - Everything Outdoor NE