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2012 Virgin London Marathon Application Form

Thank you for your interest in participating in the 2012 Virgin London Marathon for Everyman.  Please submit the form below to complete your application.

 

Please note: all applications are subject to a pledge to raise a minimum sponsorship level of £1800. As we receive a large number of enquiries for our limited places your application will be judged on the details you submit below so please ensure you give us as much information as possible to help us review your application.

Once you have submitted your form you will receive an email to confirm receipt of your application. We will then be in touch again after the results of the public ballot.  

Closing date for all applications: 31st October 2011

 

Please confirm which event you would like to participate in:

2012 Virgin London Marathon for Everyman

 

1. ABOUT YOU

Title

First name*

Surname*

Address*

Postcode*

Age

Daytime Tel

Mobile

Email*

Please note: We will be keeping in touch with the team via email so please provide an email address above that you check on a regular basis.

We may also contact you from time to time about other areas of our work, from fundraising events to new research related campaigns. Please tick here if you do not wish to receive these emails.

Why do you specifically want to run for Everyman?

Name of employer and
your job role

Will your employer be supporting you with your fundraising? If so, please give details.

They may choose to sponsor you, match or part match your fundraising total, or allow you to promote your fundraising on the work intranet.

Your FREE Everyman Running Vest

 

All members of the running team will be provided with a FREE Everyman Running Vest please indicate your preferred size

Small
Medium
Large
Extra Large

*Please note : all vests are unisex size

 

2. ABOUT YOUR FUNDRAISING

How much do you hope to raise?*

£

Have you ever done any fundraising before?

If yes, what did you do and how much did you manage to raise?

Your Fundraising Plans

Please give us details of how you plan to go about your fundraising. Our Fundraising Team will be on hand from registration to beyond the finish to help you with ideas and advice but please outline your current ideas/plans below.

TOP TIPS:

* Try to break your target down into achievable blocks and think about how you would raise each amount.
* Think about work/social contacts you have and any social activities you take part in e.g. are you a member of a club or sports team?
* Could you organise any events or activities in your local area or at work to boost your fundraising potential?

 

Please include as much information as possible as these details will affect whether or not your application is successful.

 

3. HOW DID YOU HEAR ABOUT US?

How did you hear about Everyman’s places in this event?

         

Are you happy for our press department to contact you should your local paper be interested in local runners?

 

4. YOUR COMMITMENT TO US

The pledge below will only come in to effect if you are successful in gaining a guaranteed place on the 2012 Virgin London Marathon team. Please tick the pledge box below to agree to the conditions of this place in order for us to process your application.

* I confirm that to the best of my knowledge my general state of health is good and I take full responsibility of my fitness to take part. I understand that I am required, and will endeavour to raise as much as possible for Everyman. I give Everyman permission to use any photographs/videos taken of me to raise money and/or awareness for Everyman's work

I acknowledge that all funds are to be given to Everyman by one month after my participation in the Virgin London Marathon. I understand that if the total raised is less than the minimum sponsorship target set by the charity for this event, I will pay the outstanding sum to make such monies equal to the minimum target. I absolve Everyman from any injury, loss or damage caused through participation in The Virgin London Marathon.

 

Please note: the information in this form will be sent over an unencrypted connection which could be accessed by a third party. If you are happy to proceed please click the submit button below. If you would prefer to print a copy of the form and send it by post please return it to: Everyman, 123 Old Brompton Road, London, SW7 3RP.
We record your details on our database to process your donations and so that we can keep you informed about our work. If you do not wish to receive information by post please tick here

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