Title: First Name: . Surname

LONDONMARATHON 2018

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Golden Bond Application Form /

Please complete the following application form if you would like to apply for a guaranteed Golden Bond place. We will contact you in October to let you know if you have been successful.

Title:……………… First name:…………………………………………….………………………………Surname:………………………………………………………………….....…………………………………

Home address:………………………………………….…………………………………………………….

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Postcode:………………………………………………………………………………………………………..

Work (or daytime) No:……………………………………………………………………………………..

Home No:………………………………………………………………………………………………………..

Mobile No.:……….……………………………………………………………………………………………

Email address:……………………………………………………………….………………………………..

Date of Birth:………………………………….……………………………………………………………….

Occupation:…………………………………………………………………………………………………….

Place of Work:……………………………………………………………….……………………………….

Ethnicity:…………………………………………………………………………………………………………

About the Hospice

How did you find out about St. Luke’s Hospice and the London Marathon 2018?

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Why would you like to run the London Marathon 2018for St. Luke’s Hospice?

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Fitness

Do you have any Running experience? Yes □ No □
If Yes, how many years?………………………………………………………………………….
How many miles per week are you currently running (aprox) ………………..
Have you ever run a marathon or half-marathon before?Yes □ No □
If Yes, what was your best time: ____H _____M _____S event:…………………………………………………………………………………
Have you ever run in any event for St Lukes Hospice before? Yes □ No □
If Yes what event/s: …………………………………………………......

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How do you intend to train for this event?

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What is your estimated time for the London Marathon 2018?

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Do you belong to any sporting clubs or a gym? If yes, please state below

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Fundraising

To receive a bond place with St Lukes Hospice you will be required to raise a minimum sponsorship. If you are offered a place you will be asked to sign a pledge confirming you will raise the minimum sponsorship.

Have you ever done any fundraising before? Yes □ No □
If yes, please give details and list any fundraising along with how much you have raised for St Lukes Hospice:

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How do you plan to reach the minimum sponsorship level? What are your likely sources of sponsorship? (work colleagues, clients, clubs, schools etc.)

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Other details

Please complete to ensure you get your FREE running vest/T-shirt

Please CIRCLE SIZE:

Female: S (8-10) M(10-12) L(12-14) XL(14-16) or 2XL(16-18)

Male: S M L XL or 2XL

*Please note that the men’s t-shirts do come up a little small, so when in doubt order the next size up. All runners will have the opportunity to try on and change size if need be, before printing.

Name on t-shirt:………………………………………………………………………………………………..

Please print in clear capital letters the name or nick-name you would like printed on your t-shirt

Signature …………………………………………………………………….Date ………………………………………

Thank you!Please return this form as soon as possibleto:-

Kerry Chambers

Virgin London Marathon 2018

St. Lukes Hospice

Fobbing Farm

Nethermayne

Basildon

Essex

SS16 5NJ

OR by email to:-