Saturday 2nd July 2011

ENTRY FORM

Closing date for entries: 24th June 2011

First name / Last name
Address
Postcode
Telephone Number / Email
I will take part in the 4km / 10km route(please circle/delete appropriate)
I aim to walk / run(please circle/delete appropriate)
I will be taking part for Turner Syndrome Support Society[UK]
Registered Charity Number 1080507 SCO28862
I am likely to bring [number] supporters
I will be accompanying children under 15 (please detail names and ages below):

I, the applicant warrants that I, and any participants under the age of 15 that are accompanying me, are fit to take part in the FSI Challenge. Any insurance is the responsibility of me as an individual participant.*

Signed: / Date:

For more information about the FSI or the Challenge contact Sophie Thompson at or on 0207 009 3543.Ingestre Court, Ingestre Place, LondonW1F 0JL

*The FSI, its sponsors or suppliers will not be liable for any loss, damage, illness or injury whatsoever directly or indirectly occasioned by or resulting from the negligence, wrongful act or default of The FSI, the charities it supports, its sponsors, or their respective servants or agents or from any other cause, including any act of God or the physical condition of the participant.

Data Protection Act:

The FSI will process your personal data (as defined by the Data Protection Act 1998 (“the Act”) for the purposes of your entry to and participation in all FSI Challenges, keeping you informed about our work promotions and future events run by the FSI and third parties, achieving the charitable objectives and marketing of a charitable organisation and fundraising. The FSI and its sponsors, assigns and licensees using your photograph and film image or a sound recording of you for any legitimate purpose without remuneration.

If you would like The FSI to stop processing your personal data following the FSI Challenge please let us know by writing to The FSI, Ingestre Court, London, W1F 0JL. Please note that by requesting this you will not be informed about future events.The FSI, Registered Charity Number: 1123384