(Registered Charity1153851)
BUPA London 10k
Monday 30th May
Registration Forms and Essential Information
Introduction
Thank you for considering signing up for the “BUPA London 10k”.
You will need to complete the registration form and return it to us with your deposit of £20 to guarantee your place.
If you need guidance completing the forms please call the office on 01280 821334. You should retain a photocopy of your completed form.
Please send these to:
BUPA London 10k
Registration
RP Fighting Blindness
PO Box 350, Buckingham
MK18 1GZ
Thank You!
Registration
Please complete all of the following sections in order to register
Contact Details
Title:
First Name(s):
Surname:
Home Address:
Post Code:
Telephone (day):
Telephone (mobile):
E-mail:
2. Personal Details
Date of Birth: DD/MM/YYYY
Sex: M / F
Other (optional) Information
Your Occupation:
Have you ever participated in a running event before? YES/NO
Have you raised money for charity before? YES/NO
Are you taking part with a friend, relative or colleague? YES/NO
If so, please note any other participant’s name(s) here:
Declaration
I would like to take part in the BUPA London 10k and confirm that I will raise a minimum of £200 to support the work of RPFB.
I enclose my deposit of £20 and I understand that this is not refundable in any circumstances once I have been accepted on the run. Once accepted this will be credited to my total fundraising target.
I agree to act ethically at all times and in accordance with the guidelines provided by RP Fighting Blindness when representing the charity as a challenge fundraiser.
Signature: Date: DD/MM/YYYY
Thank you
Terms and Conditions (Small Print)
1) If you withdraw from the event you must notify RP Fighting Blindness at the earliest opportunity. If this occurs you agree to pay any costs incurred by the charity. Your deposit will not be refunded and any money raised will be retained as a donation.
2) You agree to raise as much as you can to support RPFB in its work to find a cure for Retinitis Pigmentosa. Deadline for the minimum of £200 raised must be with RP Fighting Blindness by 31st December 2016.
3) All money raised must be paid to RP Fighting Blindness, registered charity no. 1153851. You send all sponsorship money to our Buckingham office clearly identified as sponsorship for your participation OR submit monies through justgiving.com.
4) You will inform us of any public event that you arrange and when collecting money will comply with all relevant by-laws, regulations and legislation and will cooperate fully with the charity. You will provide information on request and in good faith.
5) You will keep address or contact details of all your sponsors (we may ask for these details) and thank them appropriately.
6) You will keep all moneys raised on behalf of the charity safe and separate from other funds.
7) You will not reproduce the RP Fighting Blindness logo without permission.
8) Any material you are authorized to produce will include our registered charity number (1153851).
9) You understand that you have no authority to enter into any commitment on behalf of or in the name of the Charity.
10) You are solely responsible for all taxes or other duties levied against your fundraising.
11) You will not raise funds by carrying out house to house collections.
12) We reserve the right to withdraw your running place.
13) You will not do anything to bring the name of RP Fighting Blindness into disrepute.
14) You take part in the event at your own risk. We do not accept any liability for any loss or damage, however arising, or from cancellation of the event.
Next of Kin
(Please write clearly in capital letters giving full name, address & telephone numbers)
Name:
Address:
Daytime and Evening phone numbers:
Mobile number:
Relationship:
7. Declaration
Signature: Date:
Thank you, please now return the forms and deposit to the address on page 2.
Registration forms