/ Own Place Registration Form

Virgin London Marathon

Sunday 28th April 2019

Personal Details

Title: / Forename: / Surname
Home Address:
Postcode:
Home Tel: / Mobile Tel:
*Email Address:
*This is our primary form of contact throughout your London Marathon experience
Occupation: / Company Name:
Please indicate what size running vest you require? / Mens S [ ] M [ ] L [ ] XL [ ]
Womens S [ ] M [ ] L [ ] XL [ ]
Other information
How did you hear about our involvement in the marathon? Please name the publication, website, placing of advert etc.
Why would you like to run the London Marathon for the Blue Cross? – please give as much detail as possible
How much do you anticipate to raise for Blue Cross? / £
Running Experience
Have you run the Virgin London Marathon before? YES/NO
What time do you think you will complete the Virgin London Marathon in?
Do you plan on running in fancy dress? YES/NO
If yes, what as?

Pledge

I confirm I am the over the age of 18 and have secured my own place in the Virgin London Marathon 2019 through the Official Ballot.

As I have secured my own place in the Virgin London Marathon 2019, I understand that by completing this form I am not required to pay a deposit or raise a minimum amount of sponsorship. I will however use my best endeavour to raise as much as I can for Blue Cross.

I give Blue Cross permission to reproduce photographic or video images, in which I appear, and the information and quotations from any interviews, in any form, in perpetuity. I agree to these materials being reproduced in any publication or feature, in any media, that furthers the aims of Blue Cross. I understand that the material will be held on the Blue Cross photo library database.

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

Please return this form to:

Gina Davies, Blue Cross, Shilton Road, Burford, Oxfordshire, OX18 4PF /

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