Please tick to confirm*
This form is for people who have already got their place in an event - please tick to confirm you have booked your place

Event Name*

Event Date*

Your Name*

Your Date of Birth (DD/MM/YYYY)*

Home Address*

Postcode*

Your Contact number

Your Email*

Twitter Handle

Employer

Does your employer offer matched giving?
yesno

Have you fundraised for charity before? If Yes, please give brief details

How did you hear about us?*
A friend recommended Grant A SmileMy employerI recieved a letter through the postI recieved a phone callI read about Grant A Smile onlineI saw somethign on FacebookI saw something on TwitterI saw something in a magazineGrant A Smile support a family memebr/friendOther

Why have you choosen to take part in this challenge?

What is your personal fundraising target?

T-shirt size (please note: if you require a cycling jersey for your event, they come up small so please request a size up) *
smallmediumlargeXL

Are you happy for Grant A Smile to use any relevant photos of you to help promote its work and inspire other supporters? *
yesno

I would be happy to receive communications from Grant A Smile
EmailPostTelephoneNone of the above