Submit an Event

 
 

Walk to Remember

Sunday 13th October, 2019
Enjoy a three mile walk with family and friends and share memories of loved ones.

Booking Details

Participant Type: *
Adult £10.00
Title*
Forename*
Surname*
Address Line 1*
Address Line 2
Town*
Post Code*
Please separate your post code into the two boxes
Telephone No.*
Date of Birth*
E-mail*
Please confirm your email address*
Emergency contact name*
Emergency Telephone*
Relationship to you*
Medical Conditions*
Do you have any medical conditions we should be aware of? If you don't, please enter 'none' in the box.
Do you have a particular reason for taking part? If so, please share your story or experience with us here.
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
Group name
Please enter your Group Name if you are taking part in a group.
How did you hear about this event?*
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
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.