GOSH BikeRegister application form

Use this form to apply for your free BikeRegister stickers and account

1. Collect your sticker from Daphne Laurence Executive Office, Level 2,

Barclay House, T: 020 7405 9200 x5271 E: daphne.lawrence@gosh.nhs.uk. Tuesday ONLY.

Please note there are two stickers with identical numbers and ensure that you take both

Then

2. Complete all mandatory fields in this form including the registry sticker number and submit.

3. Apply your sticker to the bike frame.

4. You will receive an email from bike register to complete the process and upload photos of your bike etc (may take a week or so)

5. If you get stuck email mark.hayden@gosh.nhs.uk.

Name

Address

Postal Code

Email Address

Phone Number