Do something amazing and sign up to our March Myton Skydive today! "*" indicates required fields Unique IDYour skydive... Please select your preferred skydive date*Please note free places are on a first come first serve basis dependent on raising my minimum amount to take part. Your date may change depending on availability. Saturday 14th March Sunday 15th March Are you taking part with someone else?*We will do our best to allocate you and your party the same start time. If you’re unsure now, you can let us know at a later date. Yes, I'm taking part with someone No, I'm taking part on my own Unsure at this moment Please provide the first name and surname of each person in your party*T-shirt size* Small Medium Large XL XXL XXXL No Thank You Health and safety*In line with the event organisers’ health and safety restrictions below, please ensure you comply on the day of the event. Unfortunately, if you do not meet these requirements, you will be unable to participate. We do have alternative options and if you would like to discuss this further, please email challengeevents@mytonhospice.org I confirm that my weight will not exceed 95 kg (14.96 st), or 83 kg (13.07 st) if I am under 5 ft 4. Your details... Title* Mr Mrs Miss Ms Dr First name*Surname*Email* Mobile number*Are you over 18?* Yes No Are you over 16*You must be a minimum age of 16 to take part. Anybody who is under 18 years old will need a parent or guardian who can also sign their forms. Yes, I will be over the age of 16 on the day of the event No We are incredibly sorry but you have to be over the age of 16 to take part in this event. You will not be able to complete your registration. Date of BirthDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Please let us know the name of the responsible adult who will be taking part with you*Your 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*AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsBilling State***Please select a state**ALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPAPRRISCSDTNTXUTVTVIVAWAWVWIWYYour fundraising... With your help and support, we want to raise £40,000 from this event so we can continue to provide our services free of charge to people with life-limiting illnesses, and their families, now and in the future. In return for a free place, please pledge to raise below...Pledge* I pledge to raise a minimum of £100 before 12th December 2025 and a minimum of £450 by 10th March 2026 Why are you supporting Myton? 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*Please let us know why*Where did you hear about this event?*You can select multiple Email Facebook Flyer Friends, family or word of mouth Instagram LinkedIn Myton's website Newspaper / Magazine Other Other website Poster Roadside banner Twitter Please tell us where*Find out the difference your support makes... Thank you for your support and interest in Myton. We are determined to keep providing compassionate palliative and end of life care free of charge. You are really important to us and we would love to keep you updated about the impact your support has, as well as news and activities that may interest you. Would you like to hear from us by: 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 All details will be stored securely and are used in relation to the event you are taking part in. Please ensure that you read a full copy of our terms and conditions for this event by clicking here. I have read and accept The Myton Hospices Terms and Conditions for this event.* I accept 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 accept that free places are on a first come first serve basis dependent on raising my minimum amount to take part and that my date may change depending on availability* I accept I have read and accept The Myton Hospices Privacy Policy* I accept
