CLIC Sargent - Caring for Children and Young People with Cancer : Register today

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I would like to register for Practice-a-thon and I am happy to download my FREE event pack to save CLIC Sargent money
I would like to register for Practice-a-thon and have my FREE event pack sent to me in the post

I would like to register to take part in Practice-a-thon *

Title *

First name *

Surname *

Date of birth (To ensure we do not mail under 18's) *

Full name of school/group/club *

Address line 1 *

Address line 2

Address line 3

Address line 4

Town *

County

Postcode *

Please choose one option which best describes your position in the school/group/club *

If other, please specify:

Home telephone number *

Work telephone number

Mobile number

Please choose one option which best describes your School/Group/Club *

If other, please specify:

Email address *

Confirm email address *

How would you like to receive your thank you certificate? *

Approximate number of participants? *

Have you taken part in Practice-a-thon before? *

Age range of participants? *

When do you intend to hold your Practice-a-thon event? * [help]

How do you intend to fundraise? *

If other, please specify:

Are your participants going to be: *

How did you hear about Practice-a-thon? *

If other, please specify:

What is your main reason for taking part? * [help]

Would you be happy to help with any media promotion, e.g - in newspapers, radio or TV? *

CLIC Sargent will not pass your details on to anyone else. However we would like to contact you with news and information about our work. If you do not wish to be contacted by post or telephone please tick the box:

If you do wish to be contacted by email, please tick this box

* Mandatory field

Additional Help

When do you intend to hold your Practice-a-thon event?: If you are unsure when you will hold your event, please enter the month you intend to, eg, 01.01.2012Return to field (id:d9Bo)

What is your main reason for taking part?: If you do all your fundraising online CLIC Sargent will not be able to reimburse you with 25%. If you would like to keep 25% then please try to raise enough offline to enable you to do that.Return to field (id:zdHk)

Page Last Modified: 11/10/2011

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