The Myton Hospices - Two Castles interest form

Your details...

Unique ID

Title*

First name*

Surname*

Email*

Mobile number*

Are you over 18?*

Yes

I confirm I will be at least 15 years of age on the day of the event*

I confirm

Date of Birth

Your address...

Please enter your postcode and select your address*

Address line 1*

Address line 2

Address line 3

City / Town*

County*

Postcode*

Hidden

Country*

Billing State*

General information...

Would you like a Myton Running Vest?*

Yes

Please select your size*

I pledge to raise more than £100 in aid of The Myton Hospices*

Yes, I pledge to raise more than £100

Please estimate how much you think you can raise (£)

Why are you supporting Myton?

Why are you supporting Myton?*

You can select multiple here

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*

Please tell us where you heard about this event*

You can select multiple here

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

By text*

Yes

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*