Registering for Brighton Marathon 2017

Thank you for choosing to support us. By raising money for DKMS you are ensuring nobody with a blood cancer should die because they are unable to find a matching blood stem cell donor. With a diagnosis every 20 minutes in the UK we need your help to fight blood cancers such as Leukaemia, Lymphoma, and Myeloma.

Your personal details
Title: / Name: / Surname:
DOB: / Gender: Click here to select your gender
Your Twitter account: / Where do you work?
Your contact details
Address:
Town / Postcode:
Mobile: / Daytime phone:
Email:
Please provide details for an emergency contact:
Name …………………………………………………………………………………..
Relation to you …………………………………………………………………………
Mobile number …………………………………………………………………………
Your event
☐I have already secured a place from the race organisers*
☐I am applying for a guaranteed charity place and I do not already have a place
If you are applying for a charity place, there is a minimum sponsorship of £450* for this event.
What is your fundraising target £…………
Please share 5 ways you plan to reach your fundraising target:
1.
2.
3.
4.
5.
We provide a free pack to all our participants. Would you like a free goodie pack?
☐No ☐Yes
Do you want a T-shirt or a technical top? *
☐T-Shirt ☐Vest ☐Neither
*Click here to select your size
Your motivation
What is your motivation for taking part in this event?
Where did you get the idea to apply for a charity place? (if applicable)
Have you supported us before?
☐Yes ☐No
Are you participating in memory/in celebration/in support of someone?
☐In Memory ☐In Support ☐In Celebration
Their name is ………………………………………………………………………………………………………….
They are my …………………………………………………………………………………………………………....
Would you be interested in sharing your story with others?
If you would like to share, our team will get in touch to find out more. / ☐Yes / ☐No

All information will be treated with strictest confidence and will be used for our administrative purposes, to assist us with internal marketing or to supply you with further information on the work of our charity and the different ways you may wish to support us. DKMS doesn’t share this information with third parties unrelated to it. If at any time you prefer not to receive this information please contact us on 020 8747 5620 or email

Please return this form:

By email to:

Thank you