Running events registration form

 (If you have already registered with us.)

Personal information

Title: Mr Ms Mrs Miss Dr Rev Arq Captain Cllr Count Countess Dame Herr Inspector Lady Lord Mdme Msr Prof Rgn Sir Sister Ssa The Hon Mr The Hon Mrs Other

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Address

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Please tick this box if the above address is your home address:

Phone numbers

Home phone:

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Please tick this box if you are happy for Tommy's to contact you via email

Your running event

Name of event:

Date of event:

Location of event:

Do you have a confirmed place in this run? Yes
No

What size running vest do you wear? Please select...XSSMLXL

Further information

Do you have a specific reason for running for Tommy's, the baby charity? (please use no more than 250 characters)

Is there anything we can do to help with your fundraising? (please use no more than 250 characters)

Declaration

I understand that I should seek medical advice from my general practitioner if I am in any doubt about my physical ability to take part in this event. I acknowledge that I am taking part in this activity entirely at my own risk and that Tommy’s, the baby charity shall not be liable in any way for any injury or loss that might occur as a result of my participation. I understand that Tommy’s will in no way be liable for any claim which may arise from this event.

I agree to pay all sponsorship money raised to Tommy’s.

Your details will not be passed on to other organisations, but we may wish to send you further information about our work. If you would like to receive such mailings, please tick this box.