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

Height in feet*

Weight in stone (max. 12st 2lbs/77kg)*

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

How did you hear about this challenge?*

I would like to do my wing walk at Breighton Airfield, Selby

I would like to do my wing walk at Wickenby Airfield, North Lincs

Date of birth*

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 have read and agree to the terms and conditions and will raise or pay the minimum of £700 sponsorship no later than two weeks after the date of the wing walk. I understand that I will be contacted by St Gemma's Hospice and a third party if the money is not recieved two weeks after my wing walk date.

I agree to the declaration