Allocation of London Marathon Gold Bond places will depend entirely on the information given on this form, so please provide as much information as possible in all sections of this form.

Title / First name / Last name
Address / Postcode
Daytime contact number
Email
Date of Birth (required for VLM official entry)
/ / DD / MM / YEAR
Company / Occupation
Predicted finishing time (required for VLM official entry)
hours minutes
If you are taking part with a friend/colleague who is wishing to join Team MacIntyre what is their name/s? (Please note that we need one completed form for each runner)
If you are fundraising with other runner/s who are part of Team MacIntyre please list their names

How did you hear about Team MacIntyre’s Golden Bond places?

Please tick the statement which applies to you:

 I have entered the Official VLM Ballot  I have not entered the Official VLM Ballot

We ask everyone awarded a Team MacIntyre Golden Bond place to raise a minimum of £1,750. Please tell us how much you think you could raise if awarded a place:

£

Why do you wish to run the London Marathon for Team MacIntyre?
Team MacIntyre Running Kit
Please let us know which free piece of Team MacIntyre kit you would like to run in if successful in gaining a place:
MENS  t-shirt OR  running vest
LADIES  t-shirt OR  running vest
SIZE X Small Small Medium Large X Large  XXL
Name Letter Order (maximum of 6 letters which will be added to the front of your Marathon running top):
______
Your Declaration
I understand that if accepted for a Team MacIntyre Golden Bond place, I will raise a minimum of £1,750 for MacIntyre.
Signed
Date

Please take a copy for your records and return to:

Fundraising Team, MacIntyre, 602 South Seventh Street, Milton Keynes, Buckinghamshire, MK9 2JA or email:

Next steps:

1)  Results of the Official Virgin London Marathon Ballot will be emailed to all entrants in October.

2)  Once these results have been announced in October, we will start allocating our Golden Bond places.

3)  If you were lucky in the official VLM ballot and received your own place, we’d be thrilled to have you on the Team. To join us simply email , phone 01908 230100

4)  If you were unlucky in the official VLM ballot or didn’t have a chance to enter and you wish to continue with your Team MacIntyre Golden Bond application, please contact us after the ballot results are announced in October by emailing or phoning 01908 230100.

Thank you and good luck with your application.

¨  Your details will be kept by MacIntyre to process your application. Please tick here if you’re happy for us to keep your information to inform you about our work and ways you can support us. Your details will be kept securely and will not be shared with any other organisation.

MacIntyre is a Registered Charity Number 250840

Tel: 01908 230100, Email:

www.macintyrecharity.org

MacIntyre, 602 South Seventh Street, Milton Keynes, Buckinghamshire, MK9 2JA