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Bristol Men's Walk

Saturday 10th February, 2018
6 Miles / Pie / Pint / England v Wales Six Nations

Booking Details

Participant Type: *
Adult £18.00
Forename*
Surname*
Address Line 1*
Address Line 2
Town*
Post Code*
Please separate your post code into the two separate boxes
E-mail*
Telephone No.*
Emergency Contact Name*
Please provide details of a contact in case of emergency.
Emergency Telephone*
Their relationship to you
Group name
Please enter your Group Name if you are taking part in a group.
Are you taking part in memory of someone?
If you are taking part in memory of a loved one, please enter their name.
Relationship to you*
Date of Birth*
Please use the format DD/MM/YYYY
Medical Conditions*
Do you have any medical conditions we should be aware of? If none, please state.
How did you hear about this event?*
Declaration*
Yes.
I confirm that I/my group wish to enter this event and understand that I/we do so at my/our own risk and that St Peter's Hospice will not accept liability for any injury or loss as a result of my/our participation but I/we understand that my/our statutory rights remain unaffected. I/we agree that I/we should seek medical advice from my/our general practitioner if I am/we are in any doubt as to my/our physical ability to participate in the event. By completing this form you are giving your permission for any photographs taken of you/your group to be used in future publicity. I understand that the entry fee I have paid for this event is non-refundable and non-transferable.
Contact by mail*
Yes.
No.
Contact by phone*
Yes.
No.
Contact by email*
Yes.
No.
We would love to keep you updated with news about our work and fundraising activities. We will never sell your personal information to third parties, but we may need to share your details with suppliers who work on our behalf. See our Data Protection Policy on our website for more information on how we use and protect personal information. You can change the way we communicate with you at any time by calling us on 01275 391400 or emailing community@stpetershospice.org