Lake District Challenge 2023 **Discount offer**

Lake District Challenge 2023 Discount offer

Personal details

Title

First Name

Last Name

Phone

Whichever is your preferred number

Date of Birth

Your meningitis experience

Are you willing to share your story with the media and help us to raise awareness about meningitis, the work of Meningitis Now and your involvement?

If yes and are happy to give some brief details, please write below

Address

Street address

Town

County

Postcode

Payment details

Single registration £15 *discount offer*

Event details

How did you hear about this event

Other - how I heard

Why are you interested in this event?

Other - Please specify the reason

If you are taking part in memory or in celebration, what is your relationship with the person?

Have you fundraised for a charity before? If so please give details

Please outline your fundraising plans and ideas the raise the minimum sponsorship (£600)

Please give as much detail as possible

Eight weeks after the event, we will email you an electronic certificate to reflect your fundraising total. If you would prefer your certificate by post please tick here.

Please post my Certificate

Does your employer offer a matched giving scheme? If so please give details

Accommodation will be in twin rooms. If there is somebody you would like to share a room with, please give their name below and we will try to accommodate your request:

T-Shirt details

Please select the size of T-Shirt you would like

What name would you like on your T-Shirt? (max 10 characters)

Fitness

Please rate your fitness out of 10

5/6 means you can walk for 4 hours, 9/10 means you can walk for 8 hours

Do you exercise regularly?

If so, please list what you do

What training are you planning to do ahead of this event?

Have you ever done any events like this before?

Emergency contact details

Emergency contact name

Emergency contact number

Emergency contact relationship to you

Keep in Touch

We’d love to stay in touch and share our news on how we are working tirelessly to save lives and rebuild futures through the work we do. Please tell us how you’d like to hear from us:

yes pleaseno thanks

Phone

yes pleaseno thanks

We will send you occasional postal information based on our legitimate interest to communicate with you. You can change your preferences at any time by contacting us at supporters@meningitisnow.org or by updating your preferences online. Your details will be kept safe - check out our privacy policy for more details.

T&Cs

By submitting you agree to the Terms and Conditions below

I agree

Terms and conditions

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Contact Information