Royal Parks Foundation Half Marathon

8 October 2017

St Christopher’s Application Form

Please note: in order for us to allocate one of our places it is important that you complete all the boxes below or we cannot register you on the official race website

Personal Details

Title / Male/Female / First name
Last name / D.O.B / Age on day of race
Address
Postcode / Occupation
Home telephone number / Work telephone number
Email address / Mobile telephone number (for your SMS txt of finish time)
Next of Kin name / Next of Kin home telephone number
Next of kin mobile telephone number
Where did you hear about the
St Christopher's Hospice team? / Have you ever taken part in a running event before? If yes what was it and when?
Why do you want to run for
St Christopher's Hospice? / Do you have any medical conditions or allergies?

Fundraising

Have you ever run a race on behalf of a charity, which one? / How much did you raise?
How much do you expect to raise for St Christopher’s Hospice in the 2017 Royal Parks? / Will you be running for more than one charity?
How would you raise this amount? / Will your company match your sponsorship?

Declaration

I would like to apply for a guaranteed place in the 2017 Royals Parks Foundation Half Marathon. I pledge to raise the minimum sponsorship of £350.00.

Signed Date

Please return this form to:
Remi Knight, Community Fundraiser, St Christopher's Hospice,
51 – 59 Lawrie Park Road, London, SE26 6DZ
If you have any queries, please call Remi on 020 8768 4577 or email

·  You must be aged 18 years or older on the day of the Race.

·  Guaranteed places will be allocated on a first come first served basis.

·  By accepting one of our guaranteed places, you pledge to raise a minimum of £350.00 for St Christopher's Hospice.

·  Guaranteed places are limited and will be allocated on the basis of our receiving your completed and signed entry form.

·  If you are unable to participate in this running event for any reason, all donated monies collected in support of St Christopher's Hospice must be offered back to the individual sponsors or forwarded to the charity if the sponsors do not want their donations returned.

Thank you for taking the time to complete this form

By taking part in this race you consent to the use of photographs and audio/video clips used to promote the aims and work of the St Christopher’s Group. This could include using it to illustrate talks, presentations and written material (eg journal articles, book chapters etc) by St Christopher’s staff, in fundraising material, for publicity and education/teaching purposes to raise awareness of services, in print or on the St Christopher’s websites and social media including Twitter, Facebook, Instagram, Pinterest, You Tube and Google+

Please tick this box if you do not consent □

We would like to keep you informed about the work of St Christopher’s Hospice and other events in the future. Please tick this box if you would prefer not to hear from us. We will never pass your details on to anyone else. □

St Christopher’s Hospice, 51-59 Lawrie Park Road, London SE26 6DZ

www.stchristophers.org.uk

Registered charity 210667