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*

Date of Birth*

Step 2 - Please enter further information

Reason for taking part

Would you like a fundraising pack and St Gemma's T-shirt to be sent out to you?*

If you would like a T-shirt, what size would you like?*

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 by completing this form, I am registering my interest only for a Wing Walk with St Gemma's Hospice.

I understand that I will need to register for a Wing Walk with Wingwalk Buzz. I understand that St Gemma's Hospice will send me further information in order to register for a Wing Walk.

I understand that my information will be registered both with St Gemma's Hospice and Wingwalk Buzz.

I understand that St Gemma's Hospice do not organise Wing Walks. The Wing Walk is organised by Wingwalk Buzz.

I understand that by registering my interest with St Gemma's Hospice and registering with Wingwalk Buzz, I will be contacted by St Gemma's Hospice about the challenge and raising sponsorship.

I understand that if I choose the 'Walk For Free' option, I must commit to raising a minimum of £599 sponsorship for St Gemma's Hospice.

I agree to the declaration