Event Booking

Step 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

What is your reason for taking part in this event?*

How did you hear about the event?*

Are you supporting St Gemma’s in memory of someone?*

I am remembering (Full Name)

Are you registering on behalf of someone under age 18?*

If so, what is the name of their guardian

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 while there is no minimum sponsorship target I will try and raise as much sponsorship money as possible for St Gemma's Hospice.

I agree to attend the mandatory firewalk training taking place at 6.30pm on Thursday 13^th October 2022 before I complete the firewalk.

I understand that I must be a minimum of 14 years of age on Thursday 13^th October 2022 in order to take part in the firewalk. Parental permission is required for participants under the age of 18.

I understand that by registering for the Firewalk I will be contacted by St Gemma's Hospice about the event and raising sponsorship.

I agree to the declaration