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The Midnight Walk

Saturday 13th July, 2019
This year, join us for a special edition of The Midnight Walk and a superhero theme!

Booking Details

Participant Type: *
Early Bird £17.50
Title*
Forename*
Surname*
Address Line 1*
Address Line 2
Town*
Post Code*
Please separate your post code into the two boxes
E-mail*
Please confirm your email address*
Telephone No.*
Date of Birth*
Parental consent
Yes.
If you are aged 14 to 17, please tick to signify parental consent
Emergency contact name*
Relationship to you*
Emergency Telephone*
Please select the route you would like to walk*
5 miles.
10 miles.
T-shirt size*
Small.
Medium.
Large.
XL.
XXL.
I will re-use last year's t-shirt.
In memory of
If you are taking part in memory of a loved one, please enter their name.
Relationship to you
Group name
Please enter your Group Name if you are taking part in a group.
Company name
Please enter your Company Name if you are taking part as a corporate team.
Medical Conditions*
Do you have any medical conditions we should be aware of? If you don't, please enter 'none' in the box.
How did you hear about this event?*
Terms & Conditions*
Yes.
I confirm that I wish to enter The Midnight Walk and understand that I do so at my own risk and St Peter's Hospice will not accept liability for any injury or loss as a result of my participation but I understand that my statutory rights remain unaffected. I agree that I should seek medical advice from my general practitioner if I am in any doubt as to my physical ability to participate in the event. By completing this form I am giving my permission for any photographs taken of me on the night to be used in future publicity.
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 communications@stpetershospice.org