Five Valleys Walk 2024
Personal details
Title
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Mr
Mrs
Ms
Miss
Mx
First Name
Last Name
Date of Birth
Lead booker must be 18 or over. Please add date of birth as dd/mm/yyyy
Email
Phone
Whichever is your preferred number
Street Address
Town or City
Postcode
Country
About the event
How did you hear about this event?
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Leaflet
Email
Facebook
Meningitis Now website
Previous participant
Other
If other please state
Your meningitis experience
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Personal experience
Family experience
Friend/Colleague experience
Nursery experience
Pupil/Student experience
Employee experience
Professional experience
No experience
Please tick here of you are happy for us to contact you about your experience
Yes
Ticket requirements
Which checkpoint will you be starting from?
Please select...
Nailsworth
Minchinhampton
Brimscombe
Lypiatt
Slad
Pitchcombe
Standish Wood
Stroud Cricket Club
Number of
Adult
tickets at £12.50 each
Please select...
1
2
3
4
5
6
7
8
9
10
18 upwards
Number of
Child
tickets at £6.50 each
Please select...
1
2
3
4
5
6
7
8
9
10
Under 5s free
Number of
Family
Tickets (For 2 adults & 2 Children) at £35
Please select...
1
2
3
4
5
A Family ticket is for 2 adults, 2 children
Number of
Group
Tickets (equivalent to 4 adults tickets) at £40
Please select...
1
2
3
4
5
A Group ticket is for up to 4 adults
How many dogs are you bringing?
Please select...
1
2
3
4
5
If applicable
Ticket Total
£
How would you like to receive your tickets and handbook?
e-handbook/e-tickets via email
handbook/tickets by post
Additional items
Please note that additional items will be sent to you via post
Number of
Raffle
tickets at £1 each
Please select...
1
2
3
4
5
6
7
8
9
10
Reserved
Car Parking at Cricket Club
at £5 per car
Please select...
1
2
3
Number of
Adult T-Shirts
at £10 each
Please select...
1
2
3
4
5
6
7
8
9
10
Number of
Children's T-Shirts
at £6 each
Please select...
1
2
3
4
5
6
7
8
9
10
Number of
Dog Bandana'
s
at £7 each
Please select...
1
2
3
4
5
6
7
8
9
10
Additional items £
Summary
Ticket Total
£
Additional items £
Additional Donation
(Eligible for Gift Aid if you are a Tax Payer)
£22
£10
£5
Other
Other Amount
Total amount due £
Hidden Payment Totals
Adult T-Shirts sizes
Adult Small
Please select...
1
2
3
4
5
6
7
8
9
10
Adult Medium
Please select...
1
2
3
4
5
6
7
8
9
10
Adult Large
Please select...
1
2
3
4
5
6
7
8
9
10
Adult XL
Please select...
1
2
3
4
5
6
7
8
9
10
Adult XXL
Please select...
1
2
3
4
5
6
7
8
9
10
Children's T-Shirts sizes
Child size 7-8 yrs old
Please select...
1
2
3
4
5
6
7
8
9
10
Child size 9-11 yrs old
Please select...
1
2
3
4
5
6
7
8
9
10
Emergency contact
In the event of an emergency on the day, who should we contact:
Name
Relationship to you
Please select...
Husband
Wife
Partner
Mother
Father
Daughter
Son
Sister
Brother
Guardian
Other family member
Friend
Nephew
Niece
Uncle
Aunt
Grandparent
Contact number
Gift aid
Thanks to the Government’s Gift Aid scheme, Meningitis Now can reclaim 25p on every £1 its supporters donate. If you are a UK taxpayer, you can make your donations worth 25% more to us at no extra cost to you.
I confirm that I am a UK Income or Capital Gains taxpayer.
I have read this statement and want
Meningitis Now to reclaim tax on the donation detailed above, given on the date shown and any
donations I make in the future or have made in the past 4 years. I understand that if I pay less Income
Tax or Capital Gains tax in the current tax year than the amount of Gift Aid claimed on all of my
donations, it is my responsibility to pay any difference. I understand Meningitis Now will reclaim 25p
of tax on every £1 that I have given.
I am not a UK taxpayer
Today's date
If your tax status, contact, or personal details change, please let us know. We will update our records accordingly
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:
Email
yes please
no thanks
Phone
yes please
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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
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Terms & Conditions
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Click 'submit' to be redirected to the payment page, please have your credit card, debit card, or PayPal login ready. You Do NOT need a PayPal account - please use the pay by credit card options.
Once you have completed your payment details, you will be redirected back to the main Five Valleys Walk Page. You will then receive a confirmation email of your purchase/donation within the next few hours.
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