Hike4Hospices Entry Form

Fun Leg Entry Form 2010

Please do not complete this form if you have already registered.
If you need to make any alterations to your registration details
please click here to contact the registrar.

All fields marked with * must be completed.

Title:

First Name:

Surname:

Address 1:

Address 2:

Town/City:

County:

Postcode:

Daytime Telephone No:

Mobile Telephone No:

E-mail address:

To keep our costs down future correspondence may be sent by e-mail so it is important that this is a valid e-mail address which is checked regularly.

Date of Birth:

Day Month Year

Tick here if under 16:

Gender:

Tick here if walking as part of a team
(Minimum 4 people maximum 10 people)

Name of team

Tick here if you would like to take the H4H bus back to your starting point. All bus journeys charged at £3.00 per person.

Where did you hear about Hike4Hospices:

If "Other" please specify:

Walkers are encouraged to use public transport or get dropped off at their start points wherever possible. Please see the Route Page for links to details of local public transport

Please be assured that we will not sell your details to any other organisation. However we would like to contact you about future news and activities for the hospices. If you would prefer not to receive this information please tick here.

I confirm that I have read the Conditions which can be found here.