RaceRunning Resource Order Form An Introduction to RaceRunning: Cerebral Palsy Sport have produced ‘An Introduction to RaceRunning resource to support the development of the new sport across the country. RaceRunning has been developed for children, young people and adults who cannot functionally run and rely on support aids for mobility and balance. The RaceRunner is a three wheeled frame where the athlete is supported by a saddle and body plate. Athlete propels against the frame using their feet, and steers using the mobility within their hands and/or arms. Athletes can do this as a recreational activity, however, competition is available during athletics events in distances from 60m, 100m, 200m, 400m, 800m and 1500m depending on experience and fitness Resource Target Audience: Athletics Clubs, RaceRunning groups & Coaches, Physiotherapists, Occupational Therapists, Parents/Guardians, Qualified Teachers and Teaching Assistants and anyone wanting to know more about RaceRunning. Cost: £6 (including VAT and delivery)  Delivery outside of mainland Great Britain will incur a surcharge.Please contact the office for details. Ordering: To order a Resource, please complete and return the below to admin@cpsport.org or Cerebral Palsy Sport, Unit 5, Heathcoat Building, Nottingham Science Park, University Boulevard, Nottingham NG7 2QJ. Registered Charity No. 1088600 Visit www.cpsport.org | follow @cpsport

RaceRunning Resource Order Form Purchase Order No: (If applicable) Number of Resources Required: Organisation: Contact Name: Invoice Address:   Post Code: Tel. No: Email: Delivery Address: (If different to the above) Add to Mailing List: Yes/No Interested in Membership: Yes/No Please return order form to: Cerebral Palsy Sport 5 Heathcoat Building Nottingham Science Park University Boulevard Nottingham NG7 2QJ Tel. no: 0115 9257 027 Email: admin@cpsport.org CP Sport Ltd. Is a Limited Company registered in England and Wales, no 04181593. Registered office as shown. Registered Charity No: 1088600. VAT no 845 2260 36

RaceRunning Resource Order Form Cheque/payment must accompany the order unless ordering through Local Authority/Local Education Authority or other official ordering systems, with official purchase order numbers. Payment Options: Please invoice for payment I have made a BACS payment: Ref ………………………. (Account Name: CP Sport. Account number: 58689468. Sort Code: 30-95-42. Name of Bank: Lloyds) I have enclosed a cheque made payable to CP Sport I wish to pay by Credit / Debit Card (There will be a 2.4% surcharge on all payments by credit card) Card Type: Credit / Debit (please delete as appropriate) Card Number: (If you are returning this form by email, please call the office to pay rather than completing this section.) Card Start Date: _ _ / _ _ Card End Date: ­_ _ / _ _ Issue Number (Switch card only): _ _ Card Security Number: (last 3 digits on signature strip) Cardholder’s name and contact details (if different from above) Name: ……………………………… Address:……………………………… ……………………………………………………………………………………. ……………………………………… Post Code: …………………………… Email: ………………………………. Telephone: ………………….……….. Signature: ……………………….…. Date: ………………………….………. * Note: Unless clearly marked as payment by debit card it will be assumed that payment is by credit card and the 2.4% surcharge will be incurred. CP Sport Ltd. Is a Limited Company registered in England and Wales, no 04181593. Registered office as shown. Registered Charity No: 1088600. VAT no 845 2260 36