Do something amazing and sign up to The Rugby Pop Quiz today! "*" indicates required fields Your details... Unique IDTeam NameTeam Captain*Entry price (per team)* Price: Please complete the details below as per your Debit / Credit card that will be used for payment... Title* Mr Mrs Miss Ms Dr First name on Debit/Credit Card*Surname on Debit/Credit Card*Email* Mobile number*Where did you hear about this event?You can select multiple.... Email Facebook Friends, Family or Word of Mouth Instagram Letter The Myton Hospices website Other website Twitter Other Your address... Please enter your address on Debit/Credit Card you wish to pay with*Address line 1 on Debit/Credit Card*Address line 2 on Debit/Credit CardAddress line 3 on Debit/Credit CardCity / Town on Debit/Credit Card*County on Debit/Credit Card*Postcode on Debit/Credit Card*This field is hidden when viewing the formCountry*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*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 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. We will only communicate with you in the way(s) that you have agreed to. If you change your mind about hearing from us, contact us at any time by emailing our Donor & Supporter Care Team at DSC@mytonhospice.org or calling 01926 358 383. For further details on how your data is stored visit: https://www.mytonhospice.org/privacy-policy/ I have read and accept The Myton Hospices Privacy Policy* I accept Total
