HACT application form: London Marathon 2016

Thank you for expressing your interest in running the Virgin London Marathon 2016 for HACT!

This form will help us make our final team selection. Please either email it to or post it to the following address:

Rosie Heydenrych

HACT

49 – 51 East Road

London

N1 6AH

Full Name
Job Title
Organisation
Email
Contact Numbers
Home:
Work:
Mobile:
Address
City
Postcode
Sex
Emergency Contact
Running top size (S,M,L,XL)

Please answer the following questions:

  1. How did you hear about HACT Marathon Places?
  2. Are you a keen runner or sportsperson? Or have you run a marathon before? Please give details.
  3. How much do you expect to raise?
  4. Please tell us about your fundraising plans?What is your past experience of fundraising?
  5. Why do you want to run for HACT?
  6. Have you or your organisation worked with HACT before that you are aware of?
  7. Please tell us about any existing injuries or medical conditions?

In November 2015 (or on place confirmation after November) we willrequest a cheque deposit of £300, which will only be cashed after the race if the target is not met. By returning this form you are confirming that if selected you will send in the registration cheque when requested.

Terms and Conditions

  • HACT reserves the right to refuse an application at its absolute discretion. By signing this application form you are committing to raise a minimum of £1,500 for the charity (excluding gift aid) by 24th April 2015.
  • You must be 18 years or over on the day of the race.
  • If you are unable to participate in the event for any reason, all donated monies collected in support of HACT must be forwarded to the charity or returned to the individual sponsors. Monies already received by the charity cannot be refunded.
  • You must contact HACT immediately if you think you are going to be unable to participate.
  • When HACT establishes contact described as “urgent”, runners must respond via email/telephone/in writing as quickly as possible.
  • By signing up to the London Marathon you are consenting to HACT using any images of you in their promotional materials. Please contact us if you are unhappy with this arrangement.
  • If you fail to return your timing chip at the end of the race, any costs incurred by HACT will automatically be transferred to you.

Privacy Statement

HACT collects and uses the information you give us so that we, or the organisations we work with, can give you news about our work and services that can help you. HACT will not use private personal information without your agreement.

Would you like to received HACT’s monthly newsletter and other HACT-related communications. YES/NO

Declaration

I understand that if awarded a Virgin London Marathon 2015 Golden Bond place, I am undertaking a pledge to raise a minimum of £1,500 for HACT. I accept that it is my responsibility to consult my GP for advice before embarking on marathon training, should I be awarded a place.

Signed: ______Date: ______