Registration Form About me:
Group Walkers:
Title:................ First Name:........................................ Last Name:.................................................................. Date of Birth:................................................ (Must be over the age of 18 to be lead contact) Address:.............................................................................................................................................................. ......................................................................................................... Postcode:............................................... Contact Number:..................................................... Email:...........................................................................
(If you are walking as part of a group, please enter the names of your group below, Walkers under the age of 17 will be in the responsibility of the lead contact above unless otherwise stated. Please continue onto a separate page if necessary). Group Name:................................................................................................................................................................ Name 1: ................................................... Date of Birth..................... Email............................................................ Name 2: ................................................... Date of Birth..................... Email............................................................ Name 3: ................................................... Date of Birth..................... Email............................................................ Name 4: ................................................... Date of Birth..................... Email............................................................ Name 5: ................................................... Date of Birth..................... Email............................................................ Name 6: ................................................... Date of Birth..................... Email............................................................
Yes please, I’d like to hear about Saint Michael’s services, activities and events via post, [ ] email [ ] phone [ ] No thanks, I do not wish to hear about Saint Michael’s services, activities and events [ ]
Entry Fees: Early bird offer – hurry, £20 if you register before May 15th From May 15th Adult: £22 Children (16 & under): £15(no children may walk unaccompanied) Please make cheques payable to: ‘Saint Michael’s Hospice’. [ ] Alternatively to pay by card, please tick here and one of our team will call to take payment. Please register before Friday June 9 [ ] I agree to the Let’s Glow terms & conditions available at www.saintmichaelshospice.org Signed:......................................................................
Please return your completed registration form(s) and entry fee to: Saint Michael’s Hospice, Crimple House, Hornbeam Park Avenue, Harrogate, HG2 8QL. events@saintmichaelshospice.org /saintmichaels @mysaintmichaels
Please pick one of the following options: [ ] Yes, I’d like to walk, please register mewith the above details and find enclosed my entry fee of £.................. (If registering as a group, please include their details and registration fees too.) [ ] Instead of walking, I would like to volunteerat this fundraising event, please get in touch with me with further information.