Great Manchester Run 10k

20th May 2018

Entry Form

Please complete details in block capitals. Photocopies are OK.

Name:

Home address:

Postcode:

Telephone: Mobile:

Email**:

Employer/Company:

Occupation:

**We respect your privacy and will not sell your personal data to any third party. See item 6 of our conditions of entry for more information.

My personal fundraising target is £______(I endeavour to raise a minimum of £150)

Please give details of how you would raise this amount, e.g. sponsorship from friends and family, collections, matched giving from your employer, organising event(s).

Is there any particular reason you have chosen to support Henshaws?

______

______

Have you previously supported Henshaws? If so, please give brief details:

Have you previously supported any other charities? If so, please give brief details:

Please send me a Henshaws:T-shirtORRunning vest

Size:SmallMediumLargeXLXXL

(Please circle your preference and size)

Conditions of entry

Please read the following conditions of entry carefully and sign:

  1. I will endeavour to raise a minimum of £150 (including Gift Aid) in sponsorship money for Henshaws Society for Blind People if offered a place in the Great Manchester Run 10k.
  2. I will pay all funds raised for this event to Henshaws Society for BlindPeople in sterling within one month of the event. I will make all sponsorship cheques payable to Henshaws Society for Blind People and send to:

Henshaws FAO: Fundraising
Washbrook House, | Lancastrian Office Centre | Old Trafford | Manchester | M32 0FP

Should I be unable to participate, for whatever reason, I will inform Henshaws as soon as reasonably possible. I will forward all sponsorship forms and monies collected to Henshaws or return it to my sponsors.

  1. I confirm I am over 15 years of age.
  2. I confirm that to the best of my knowledge my general state of health and fitness is good and that I take full responsibility for myself. I undertake to inform the organisers of any medical condition that may affect my participation. (If you are over 70 years old or if you have any medical condition that could be adversely affected by exercise, or if you are in any doubt about your health, you must obtain a medical certificate from your doctor).
  3. I participate entirely at my own risk. I hereby waive any and all claims (to the extent permitted by law) that may arise from whatever cause against Henshaws, its employees or agents for any personal injury, accident, loss, damage or public liability to myself or my personal property.
  4. Henshaws would like to keep you informed about our work and the difference you support has made. We would also like to tell you about future developments and fundraising activity. We respect your privacy and will not sell your personal data to any third party. Henshaws will only use your data to tell you about our services and fundraising, for analysis and to contact you for research purposes. We’d like to contact you in the way that suits you so please let us know if you are happy for us to contact you by email or phone

Email  Telephone

If you do not wish to receive information in the following way, please tick the relevant box:

Post  Email  Telephone 

I have read and agree to the conditions of entry above.

Signed:______

Date:______

Thank you for applying to join Henshaws for the Great Manchester Run
Please return this form to Faye Li via FAO: Fundraising, Henshaws, Washbrook House, Lancastrian Office Centre, Talbot Road, Old Trafford, Manchester, M32 0FP or email to .

Henshaws

Washbrook House, Lancastrian Office Centre, Talbot Road, Old Trafford, Manchester, M32 0FP

Registered charity number 221888