Lifelites application form

The London Marathon,April 2018

Please complete this form to register your interest in running for #TeamLIFELITES in this event.

Contact Details
Name
Address line 1
Address line 2
Town
County
Postcode
Email
Telephone number
Your shirt size
Please indicate: / Small / Medium / Large / Extra Large

Occupation:

Employer Name:

Does your employer do Matched Giving:

Running & Fundraising History

How long do you think it will take you to complete the Virgin Money London Marathon?

Have you previously run a full marathon?

⃝ YES

⃝NO

This field is required

If "Yes" please state which marathon you ran.
If "No" please state your previous running experience.

This field is required

Have you raised funds for charity before?

⃝ YES

⃝ NO

This field is required

If "Yes" please state how much you have raised, the event and the charity you raised money for.

#TeamLIFELITES Details

In the event that you are allocated a charity place, please outline your fundraising plans:

Why have you decided to run the London Marathon? Do you have a special reason or inspiration to run for LIFELITES?

This field is required

Is there anything else which you feel we should know which might be relevant to your application?

LIFELITES, on occasion, may send you information regarding other events, if you DO NOT wish to receive this information, please tick the box □

Please select one of the following

⃝ A
I wish to apply for the LIFELITES charity place and in addition, have (or intend to) applied for a ballot place through the race organisers.

⃝ B

I wish to apply only for a LIFELITES charity place and have not applied to the race organisers via the ballot scheme.

⃝ C

I do not wish to apply for a charity place. I have my own place in the 2016Virgin Money London marathon, or I have only applied for a place via the ballot. I wish to raise money for LIFELITES, and understand that there is no minimum sponsorship amount in this case.

This field is required

If you have chosen option A or option B please pledge the amount you are going to raise, please note the minimum sponsorship level is £2000 (excluding gift aid) £

Terms and Conditions

1. You confirm that the information on this form is complete and correct.
2. You confirm that you will be 18 years of age or older on 22nd April 2018.
3. You must complete the section of the Application Form, entering £2000 or more in the space provided.
4. Should you be accepted, you agree to pay a registration fee of £150. This fee falls due when your online registration is completed and must be received by the LIFELITES office within 21 days of that date. The fee will count towards your fund-raising pledge.
5. If allocated a place, you are pledging to raise your selected amount and agreeing to make up any shortfall yourself to the required minimum of £2000 (excluding Gift Aid) by the 30th of June 2018.
6. All applications are subject to a selection process to ensure that the place is used to best possible effect (at the discretion of LIFELITES).
7. If allocated a place you agree to inform LIFELITES as soon as possible in writing should you become unable to take part in the Virgin Money London Marathon 2018, at which point your minimum sponsorship obligation will cease.
8. You understand that should you withdraw from your place the registration fee is non-refundable and will be retained to cover expenses.
9. If allocated a place, you agree that images taken on the day may be used by LIFELITES to help promote our fundraising efforts.
10. If you are unable to participate in the Virgin Money London Marathon 2018for any reason all donated monies collected in support of LIFELITES must be forwarded to LIFELITES or returned to the individual sponsors. Monies already received by LIFELITES will not be refunded.
11. All participants enter at their own risk in accordance with standard Virgin Money London Marathon regulations.
12. You understand that, should you be accepted to run for LIFELITES, you will be required to also fill in the Official Virgin Money London Marathon Golden Bond Form online before the end of January 2018. As this will be done electronically via the Virgin Money London Marathon website, you understand you will need to have internet access and access to an email address at some point before this date.
By ticking this box you accept and agree to the terms and conditions listed above □

Signed
Print name
Date

Please sign and return this form to Lifelites via post or email.

R LIFELITES, 26 Great Queen Street, Holborn, London, WC2B 5BL