Event Booking

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

What is your reason for fundraising for St Gemma's Hospice?*

How did you hear about this challenge?*

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

Yes
No

Declaration

I understand that this form is an expression of interest only and my Wing Walk date will not be confirmed until St Gemma's Hospice have contacted me with further information.

I understand that if I choose a 'Walk for free' Wing Walk, I must aim to raise a minimum of £599 for St Gemma's Hospice.

I understand that by registering my interest and subsequently signing up for a Wing Walk, I will be contacted by St Gemma's Hospice about the event and raising sponsorship.

I understand that all participants must be aged 18 or over to take part in a Wing Walk and confirm that I will be aged 18 or over on the day I do my Wing Walk.

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

I agree to the declaration