REGISTRATION FORM

This document contains the following forms to complete:

  1. Personal Details Form
  2. Payment Form
  3. Medical Declaration Form
  4. Registration Declaration Form

Please complete all sections below and returnto:

Carrie Murphy

St. James’s Place Wealth Management

Festival House

Jessop Avenue

Cheltenham

Gloucestershire GL50 3SH

(If returning by email, please scan and sign)

Cheques should be made payable to ‘St. James’s Place Foundation’ or, if you are an SJP Partner or employee, the registration fee can be deducted from your Turnover Account or Payroll.

Please Note: ALL forms must be completed and returned as soon as possible to Carrie Murphy (to the above address at Festival House in Cheltenham). Places are confirmed on a first-come-first-served basis.

Personal Details

Title

First Name(s)

Surname

Home Address

Postcode

Mobile Phone

/

Home Phone

E-mail Address

Date of Birth

Sex (please “Y”)

/

Male

/

Female

Next of Kin

Person to Contact in Emergency
Relation to You
Evening Phone
Mobile Phone
Special requests?
Team Members including yourself (Please list Full Names & Dates of Birth including children under 12 running free of charge)

T Shirt order for 12 year olds and above (each paid £12 for registration)

We cannot guarantee t-shirts for anybody who registers after Monday 15th August.

Name / Size

T shirt size guide (unisex):

Size / Measurements
S / 35 / 37”
M / 38 / 40”
L / 41 / 43”
XL / 44 / 46”
2XL / 47 / 49”
3XL / 50 / 52”

Which Organisation are you from?


SJP Jessie May Other
Please (specify)

Are you a Jessie May family with a concession code?

Please write Jessie May concession code: ______

Payment Form

The charge to register is £12 for each person 12 years and over. The £12 fee includes a t-shirt that you can pick up on the day. All participants (including children under 12 years) will receive a number to safety pin on their top in the post along with timings for the day closer to the time.

Please confirm if you would like the fee to be deducted from your
Turnover Account / Payroll

Name:______

Location:______

Partner/Staff No:______

Amount:______

Bank Transfer

Please send money to:

BankBarclays

Account no.80667927

Sort code20-13-42

Confirm your reference: _

Amount transferred: £

Please quote ‘Your Surname GP’as the reference so that funds are allocated correctly e.g. if your surname is Smith, please make the reference ‘Smith GP’

Cheque

Cheques are to be made payable to ‘SJP Foundation’ and returned with your form to the address below:

Carrie Murphy

St. James’s Place Wealth Management

Festival House, Jessop Avenue

Cheltenham, GL50 3SH

Medical Declaration

I agree that I regard those who are registered on this form to be fit enough to take part in this event and understand that it involves a walk of approximately 3km. If I am in any doubt, or have a condition that affects my / one of my team’s* ability to complete the challenge I should inform the organisers. I confirm that my team* and I are entering at our own risk.

Signed ______Date ______

*Team = Names of the people registering to participate on the registration form.

Registration Declaration

Please read and sign the registration declaration at the bottom of this page.

I agree to abide by the Conditions of Entry, as attached.

I confirm that I have signed a Medical Declaration form.

I agree that it is my responsibility to arrange my own adequate insurance cover in connection with this event.

I will do my best to raise sponsorship and I understand that all sponsorship monies will go to the St. James’s Place Foundation who will then match the amount and pass the matched amount to Jessie May.

Signed: ______Date: ______

Full Name (please print)

______

Conditions of Entry

Itinerary

While we endevour to follow the itinerary set out, we reserve the right to cancel or modify the itinerary as necessary. Due to the nature of this event, arrangements have to be planned well in advance, so changes may have to be made and we reserve the right to do this. Should a material change be necessary we will inform you as soon as reasonably possible. A material change includes, for example, a significant change of destination or route.

Medical Form

Prior to the event you will be asked to complete a medical Declaration. If you have any medical condition that could be adversely affected by exercise, particularly a heart condition or asthma, you must provide the Company with a medical certificate from your doctor. By signing the pledge overleaf you are confirming that, to the best of your knowledge, your general state of health is good and that you take full responsibility for your health and personal well being.

Minimum Age

There is no Minimum age for participation. However if you are not able to run on your own you will need to be accompanied by an adult.

Challenge Participation

We accept your booking on the understanding that you realise the hazards involved in this type of event and that you are participating at your own risk. The Company accepts no liability for any injury resulting from the hazards of any other activity included in the itinerary, or for any other mishaps to yourself or your property.

Data

You agree that you are happy for SJP foundation and Jessie May to share your data for the purpose of organising the People’s Grand Prix event.