Do something amazing and sign up for The Great North Run today… "*" indicates required fields Step 1 of 2 0% Unique ID Your details... Your entry* Price: Title* Mr Mrs Miss Ms Dr First name* Surname* Email* Mobile number* Are you over 18?* Yes No Are you over 17?* Yes No We are sorry but all participants have to be 17 years of age or older to take part in this event.Date of birth DD dash MM dash YYYY Your address... Please enter your postcode and select your address* Address line 1* Address line 2 Address line 3 City / Town* County Postcode* HiddenCountry* Emergency contact name* Emergency contact number* 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 2 City / Town* Postcode* Your Run... I agree to raise a minimum of £350 in sponsorship Yes, I agree Are you an Affiliated Club Runner?* Yes No Please state club name* What is your athlete number? Would you like a Myton Running Vest* Yes No Please select your size* S M L XL 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 Please specify where* 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 The Coronavirus outbreak has had a significant impact on our ability to raise vital funds in the recent years. We had to suspend all face to face fundraising, close Myton’s 24 shops and mass events had to be cancelled or postponed. Every month we need to raise £758,333 and we are asking people to show their support by making a donation to ensure we can continue to provide our services free of charge for the people of Coventry and Warwickshire, now and in the future. Providing dedicated care and support for people with life limiting illnesses, and their families, in our inpatient beds and in the community continues to be our primary focus, and we need to raise £9.1 million this year to to do this. We can’t do it without the support of people like you!Do you wish to donate in lieu of sponsorship? Donate £10 £20 £30 £40 £50 £60 £70 £80 £90 £100 £125 £150 £175 £200 £250 £300 £400 £500 £1000 Other Please enter your amount* I wish to Gift Aid my donation and increase its worth by 25% at no cost to me I am a UK tax payer and confirm I will pay an amount of UK income tax or Capital Gains tax for each year that is at least equal to the amount of Gift Aid that all charities that I donate to will reclaim on my behalf. I understand that if I pay less Income Tax/Capital Gains Tax in any tax year than the amount claimed on my donations, it will be my responsibility to pay any difference back.Please select the appropriate statement* Yes claim Gift Aid for the last four years /and any I may make in the future, until I notify you otherwise Yes claim Gift Aid for my latest donation /and any I may make in the future, until I notify you otherwise I am NOT a UK taxpayer or do not wish to Gift Aid my donations HiddenDON 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
