All Runners Are Asked to Raise a Minimum of 300 (Excluding Gift Aid Registration Fee)

Newport MarathonRegistration Form

Sunday 29th April 2018

Please note that a non-refundable £30.00registration fee is required for your place in the event with the return of this completed form.

All runners are asked to raise a minimum of£300 (excluding gift aid registration fee).

You will receive a complimentary Bobath Wales running vest if we see you have raised £180 by 8th April 2018 with the remaining sponsorship of £120due by13thMay 2018latest.

Title: Miss / Mrs / Ms / Mr / Dr:
First Name and Surname:
Address:
Postcode:
Daytime number: / Mobile number:
Email address:
Next of Kin: / Next of Kin contact number:
Predicted Time:
Why have you chosen to run for Bobath Children’s Therapy Centre Wales?
Would our Communications and Marketing Officer be able to contact you for press
purposes?
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What size running vest would you like to be sent? (Vests will be sent out prior to race day)
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However,we'dlovetokeepintouch abouttheworkofBobathChildren'sTherapyCentreWales.
If you’d be happy to hear from us, please tick below and tell us how:

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Wouldyoubehappytohelpuswithservicedevelopment?(Surveys,questionnairesetc)

Yes

No

By signing this form you are pledging to raise a minimum of £300.00in sponsorship of Bobath Children’s Therapy Centre Wales.

Signed: ______Date: ______

Please return this form and your non-refundable £30registration fee (by cheque payable to Bobath Children’s Therapy Centre Wales or by card filling in the details below) to:

Bobath Children’s Therapy Centre Wales, 19 Park Road, Whitchurch, Cardiff, CF14 7BP

Payment details

I enclose a cheque for £______made payable to ‘Bobath Children’s Therapy Centre Wales’

I authorise you to debit my Mastercard/Visa card £_____

Card Number:

Start Date: Expiry Date:

3 digit security code:

Signature: ______

Name as on Card: ______

Gift Aid declaration

Bobath Children’s Therapy Centre Wales

Please treat



You must pay an amount of Income Tax and/or Capital Gains Tax for each tax year (6 April one year to 5 April the next), that is at least equal to the amount of tax that Bobath Children’s Therapy Centre Wales will reclaim on your gifts for that tax year.

Donor’s details

Title _____Forename ______Surname ______

Home address ______

______

Postcode ______Telephone ______

Email ______

Signature ______Date ______Registered charity: 1010183.

Please notify Bobath Children’s Therapy Centre Wales if you:

1. Want to cancel this declaration.

2. Change your name or home address.

3. No longer pay sufficient tax on your income and/or capital gains.

Tax claimed

Bobath Children’s Therapy Centre Wales will reclaim 25p of tax on every £1 you give on or after 6 April 2008.

If you pay income tax at the higher rate, you must include all your Gift Aid donations on your Self Assessment tax return if you want to receive the additional tax relief due to you.

Thank you for helping us make a difference to children in Wales

who have cerebral palsy