Own Place Notification Form
Vitality London 10,000
Monday28May 2018
Personal Details
Name:Home Address: / Work Address:
Postcode: / Postcode:
Home Tel: / Work Tel:
Mobile Tel: / Email address:
Twitter Handle: @
Instagram: @
Date of Birth:
Occupation: / Company Name:
Please indicate what size running vest you require / S [ ] M [ ] L [ ] XL [ ]
Other information
Have you run the Vitality London 10,000 before?How did you hear about the Blue Cross places? / Yes No
Fundraising
Please tell us below how you will raise this amount:Activity / Amount
TOTAL
Will your company match what you have raised?As I have secured my own place in the Vitality London 10,000 2018, I understand that by completing this form I am not required to pay a deposit or raise a minimum amount of sponsorship. I will however use my best endeavour to raise as much as I can for Blue Cross.
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………………………..
From time to time Blue Cross would like to contact you by phone and/or email with news about the pets you are helping and ways you can support us in the future. If you are happy for us to do this please delete as appropriate:
Landline Y/N
Mobile Y/N
Email Y/N
If you do NOT wish to hear from Blue Cross by post please delete as appropriate:
I do wish to hear from Blue Cross by post/I do not wish to hear from Blue Cross by post
You can change your preferences at any time by contacting our Supporter Care Team on 0300 790 9903 or email
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