Apply for an event

Your details

Title

Name *

Surname*

Address*

Address

Town/City*

Postcode*

Date of birth*

Contact details

Email address*

Telephone number*

This telephone number is my*

Twitter username

I work for

In memory or celebration?

Are you taking part in this event for someone?*

Special fund details

Name of Special Fund*

Their details

Their name*

Your relationship to them*

Event details

Entry fee: £20
Minimum target: Raise what you can!

Offer code Amount will update on next page

I will aim to raise*

I will raise this in the following ways*

I would like a

In size

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What is your motivation for taking part in this event?*

Terms

I understand that by ticking here, I have carefully reviewed and accept the fundraising terms and conditions (This link opens in a new window) for this event.*

Would you like to be kept up to date on our news and activities?

Yes, please keep me up-to-date via email.

Yes, I would like to receive text updates.

Yes, I would like to receive postal updates.

Yes, I would like to hear from you by phone.

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