* 1. I hold a current British Cycling Eastern Region Racing Licence

* 2. I have raced in the following events

* 3. I am a 4th category rider and intend to race in the East London Velo Summer Series 2014

* 4. Please indicate which statement best reflects your view

* 5. Please provide the following details about yourself

* 6. My current road racing category is

* 7. Do you have any other comments