/ Gold Bond Application Form

Virgin

London Marathon

Sunday22nd April 2018

Personal Details

Name:
Home Address: / Work Address:
Postcode: / Postcode:
Home Tel: / Work Tel:
Mobile Tel: / Preferred Email address:
Twitter Handle: @
Date of Birth:
Occupation: / Company Name:
Please indicate what size running vest you require / S [ ] M [ ] L [ ] XL [ ]
Other information
Have you applied for a place through the official ballot? / YES/ NO
How did you hear about our involvement in the marathon - please name the publication, website, placing of advert etc.
Why would you like to run the London Marathon for the Blue Cross – please give as much detail as possible
Running Experience
Have you run the London Marathon before?
Please tell us about your training and running experience
What time do you think you will complete the London Marathon in?
Do you plan on running in fancy dress? / If yes, what as?
Fundraising
How much do you think you will raise?
Please tell us below how you will raise this amount:
Activity / Amount

TOTAL

Will your company match what you have raised?
Pledge

I, the undersigned, will use to my best endeavours to raise £1,700 as a condition of acceptance of a guaranteed Blue Cross Golden Bond place. In return I agree to pay a non refundable registration fee of £100 which includes VAT.

I give Blue Cross permission to reproduce photographic or video images, in which I appear, and the information and quotations from any interviews, in any form, in perpetuity. I agree to these materials being reproduced in any publication or feature, in any media, that furthers the aims of Blue Cross. I understand that the material will be held on the Blue Cross photo library database.

Signed:Date:

Please return this form to:

Gina Davies, Blue Cross, Shilton Road, Burford, Oxfordshire, OX18 4PF /

We may contact you again regarding the work of the Blue Cross with information on how you can help us. If you would prefer NOT to hear from us please tick this box