Challenge Events Form 2017

Which challenge event would you like to apply for? *

Title *

First Name *

Last Name *

Home Address *

Postcode *

Contact Number *

Email Address *

Occupation *

Company *

Does your place of work provide matched giving for the sponsorship you raise? *

Have you applied for your own place in the event? *

If you get your own place would you still like to raise money for St George's? *

Why do you want to run for St George's? *

Do you have a link with St George's Hospital Charity or St George's Healthcare NHS Trust? If so, please give details. *

How did you hear about the St George's Hospital Charity places? *

Have you taken part in a challenge event before?

If yes, did you raise money for charity?

Name of charity

Amount you raised

How do you plan to raise sponsorship money? Please list more than one method. *

We ask that our runners wear our charity t-shirt or running vest on the day. Please state which you would prefer.

What size would you prefer?

Do you agree for your story and photograph to be used for publicity purposes? *