Register for our Coventry Cathedral Abseil for just £20 today! "*" indicates required fields Step 1 of 2 0% UNIQUE ID Your details... Your ticket*Title* Mr Mrs Miss Ms Dr First name*Surname*Email* Mobile number*Are you over 18?* Yes No Are you over 16 on the day of this event?* Yes No We are sorry but you have to be over 16 years of age on the day of this event to take part.Date of birthDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Your address... Please enter your postcode and select your address*Address line 1*Address line 2Address line 3City / Town*CountyPostcode*This field is hidden when viewing the formCountry*Your Abseil... Preferred start time*Please indicate your preferred start time. We cannot promise that this will be your exact time but will do our best to make sure this is possible. Please select your preferred time09.30 – 10.00 am10.00 - 10.30 am10.30 - 11.00 am11.15 - 11.45 am11.45 - 12.15 pm12.15 - 12.45 pm13.15 – 13.45 pm13.45 – 14.15 pm14.15 - 14.45 pm14.45 - 15.15 pmEmergency contact name*Emergency contact number*I agree to raise a minimum of £200 in sponsorship* Yes, I agree Please select your t-shirt size* Adult S Adult M Adult L Adult XL Adult XXL Is your payment information the same as your participant details entered above?* Yes No First name on Debit or Credit Card*Surname on Debit or Credit Card*Address line 1*Address line 2City / Town*Postcode* Where did you hear about this event?*You can select multiple Email Facebook Flyer Friends, family or word of mouth Instagram Lamp post sign Newspaper / Magazine Myton shop Myton's website Other website Poster Roadside banner Twitter Other Why are you supporting Myton?*You can select multiple In memory Thanks for care Hospice movement Local charity Other Please let us know the first name of your loved one*Please let us know the surname of your loved one*Please let us know their relationship to you*Why are you supporting Myton?*Find out the difference your support makes... Thank you for supporting The Myton Hospices so we can continue to provide our services free of charge to people, and their families, living with terminal illnesses. We may keep in touch with you by post and phone to tell you more about our vital work and other ways you can help, including opportunities to donate, fundraise or volunteer and how your support has made a difference. Please let us know if you’re also happy to hear from us by email and text: By email* Yes No By text* Yes No Event Registrations T&C's... Contact details provided (including email address and telephone number) are used to keep you up to date about the event you are taking part in and support you in your fundraising efforts where appropriate We may ask for next of kin details in case of an emergency. All details will be stored securely and are used in relation to the event you are taking part in. Please ensure that you are physically in person with any team members you sign up to this event and have full consent to share their details with us. If you are not their registration may be invalid. Also, please ensure that you read a full copy of our terms and conditions for this event by clicking here. Your privacy... We promise to do our best to keep your details safe and secure and will only process your data in accordance with the current Data Protection legislation. Our Privacy Policy explains how we keep this promise and you can read more online at www.mytonhospice.org/privacy-policy If you change your mind about hearing from us please email DSCT@mytonhospice.org or call us on 01926 358383. I have read and accept The Myton Hospices Terms and Conditions for this event* I accept I have read and accept The Myton Hospices Privacy Policy* I accept Total
