Event Booking

Unfortunately this event has passed. Please try another event.

Step 1 - Attendee 1 details

Title*

First Name*

Surname*

Telephone Number*

Email Address*

Postcode*

House Number and Street*

Address Line 2

Town / City*

County*

Step 2 - Please enter further information

Weight in stone (max. 100kg/15st 11lbs)*

Height in feet*

Date of birth*

Reason for taking part*

You will receive fundraising materials via email. Please tick if you would like to receive via post.

Please select if you would like a St Gemma's T-Shirt

Step 3 - How we communicate with you

As a valued supporter we really want to keep you posted about news and events across St Gemma’s and to share how your support benefits local patients and their families.

We will contact you for administrative purposes regarding this interaction. We will usually send you information by post; if you would also like to receive email updates please let us know. If you wish to change how we send you information or choose not to hear from us at all, there are a variety of ways you can do this. Ring us on 0113 218 5555, email supportercare@st-gemma.co.uk or update your preferences online at www.st-gemma.co.uk/mydata.

For further information on how we use and store your details please visit www.st-gemma.co.uk/privacy. We will never sell your personal information.

I am happy to be contacted by email in the future

Declaration

I agree to the skydive booking terms and conditions provided and agree to raise and submit £450 in sponsorship within two weeks after my jump date.

I understand that my skydive costs £230 and is paid for by St Gemma's Hospice. The sponsorship I am raising covers this cost and ensures at least £270 goes directly to patient care at St Gemma’s.

If St Gemma’s Hospice has not received my sponsorship money two weeks after my jump date, I understand that the Hospice will contact me.

I understand that by signing up to a skydive for St Gemma's Hospice, I will be contacted by St Gemma's Hospice about the event and fundraising.

I understand that all participants must be aged 16 or over to take part in a skydive and confirm that I will be aged 16 or over on the date of my skydive.

I confirm that I am at a reasonable level of health for this challenge.

I agree to the declaration