Virgin London Marathon

24 April 2016

Charity Assured Place Application Form – running for Maggie’s Barts through City A.M.

We’re thrilled to offer one lucky reader of City A.M. the chance to join team Maggie’s at the Virgin London Marathon 2016. All funds raised by this runner will go towards City A.M.’s £1m campaign for Maggie’s Barts, a new cancer support Centre coming to St Bartholomew’s Hospital in late 2016.

Allocation of our charity assured places will depend entirely on the information given on this form. Please complete this form in full and feel free to continue on a separate page if you need to. Every application received will be read by Maggie’s Development Team. This is your chance to tell us exactly why you should join us at the world’s most iconic marathon to support Maggie’s Barts.

1. Personal details

Name:......
Address:......
......
......
Telephone Numbers:
(daytime) ......
(mobile)......
Email address:......
Date of Birth:......
Company:...... / Occupation:......
Will your employer be able to support you? If yes, please provide details of who they are & how they can support you e.g. matched giving scheme
......
Your Maggie’s running vest: Small  Medium  Large  X-Large 

2. About your fundraising experience

a) Have you taken part in any fundraising activities for Maggie’s in the past? If yes please give details of the most recent below.

Date / Fundraising activity / Amount Raised

b) Have you taken part in any fundraising activities for other charities in the past? If yes please give details.

Event & Date / Fundraising activity / Charity / Amount raised

c) As a member of Maggie’s running team we would ask you to make a donation or raise £2,000 in sponsorship (not including Gift Aid).

How much do you think you could personally raise/donate if awarded a place?

£______

d) Please tell us what fundraising methods/activities you plan to use to enable you to reach this target.

3. About your running experience

a) Please provide details of any running events you have completed in the past.

b) What time do you expect to complete the London Marathon in?

4. Why do you want to support Maggie’s Barts?

Please tick any of the appropriate boxes:

 I am/was a Maggie’s Centre visitor

 I know someone who has used a Maggie’s Centre

 I’m running in the memory or in support of someone

 I have been affected by cancer

 I know someone that has been affected by cancer

 I am marking a milestone

 I have never been sporty but plan to use this as a challenge

If you have an interesting or inspiring story on why you would like to run for Maggie’s then please share it with us here:

Often your story can be inspirational for others and it can help raise awareness about Maggie’s and our events. Someone from our media team may contact you about your story. If you would rather not be contacted please tick this box □

Signed………………………………………….. Date…………………………………………..

What happens next?

  • You will receive an email to confirm receipt of your application
  • Applications must be received by Maggie’s no later than Friday 15th January
  • If you are successful, you will be notified w/c 18th January and must confirm your place and details with VLM that week, otherwise your pace will be reallocated
  • If allocated a place we will then ask for payment of the registration fee (£100) and confirm your place in writing

Send your completed application form to: Lizzie Hunt, Maggie’s, 20 St. James Street, London, W6 9RW or email to