Peter Sage Charity Health Challenge Form

Most Gyms and health clubs have a concept II rowing machine.
You can attempt the challenge as many times as you like although any time recorded under 6minutes and 38 seconds must be witnessed and signed by either a gym manager or senior member of staff. Please fill in the following form and post to:

Peter Sage Charity Health Challenge
C/O 39 Sibson Road
Birstall
Leicester
LE4 4DX

**Click on the print icon in your browser, or under the file menu choose PRINT.**

Peter Sage Charity Health Challenge

Date: _______________________________

I, (name)_____________________________________

completed 2000m on a concept II indoor rowing machine on date)____________________

at the following location________________________________________, and recorded

a time of __________________________________ .

Signed __________________________________

Witnessed By _____________________________

Position _________________________________

The Charity I would like the £50 to go to is _____________________________________

Address ______________________________________________________________

Thank you for participating.