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APPLY TO RUN FOR AUTISTICA
ABOUT YOU
Title (Mr/Mrs/Ms/Miss)*
First Name *
Surname *
Preferred name *
Male
Female *
Date of birth DD/MM/YYYY *
/
/
Home Address *
Postcode *
Home Telephone *
Email *
Mobile Number
RUNNING INFORMATION
Which run would you like to register for? *
Please select
Royal Parks Half Marathon
BUPA 10K 2011
Where did you hear about the AS Team? *
Do you already have a place in the marathon(s) but would like to run for Autistica? If so, please let us know what places you have in the box below.
Is this your first marathon?*
Yes
NO
Do you have a special reason for running with us? *
Estimated running time *
EMERGENCY INFORMATION
Do you have any existing medical conditions, allergies etc which the organisers need to be aware of?
Emergency Telephone Number *
Emergency Contact Name *
RUNNING VEST SIZE (We recommend you opt for a size larger than your chest size)
Ladies
:
Large (38")
Medium (36")
Small (34")
Men:
XL (44")
L (42")
Medium (40")
Small (38")
OR please choose a T-shirt size
Ladies:
XXL
(size 16+)
XL
(14-16)
L
(12-14)
M
(10-12)
S
(up to 10)
Men:
XL
(44"-46")
L
(42")
M
(40")
S
(38")
FUNDRAISING
How do you plan to raise the minimum sponsorship? *
How much do you hope to raise?*
Will your company match your sponsorship? *
Yes
No
PUBLICITY
Would you be happy to participate in PR ? *
Yes
No
RACE ENTRY FEE
How will you be paying your entry fee? *
Credit Card
Cheque
(Details of how to pay will be given after you have submitted this registration form)
.
DECLARATION
Please read our Terms and Conditions of entry
Please tick to confirm you have read and agree to the terms and conditions *
Data Protection Act 1988
By completing this form you consent to Autistica processing data about you We will store the information for the provision of services, administration and for fundraising purposes. In the future, we may write or email you with information about products and services associated to our work. We do not pass details to third parties to use. Please tick here if you do not wish to receive these mailings
I would like a guaranteed place in my chosen marathon / marathons. I pledge to raise at least the minimum sponsorship requested for each event I enter into.
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RESEARCH WE FUND
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RESEARCH ENDORSEMENTS
Prof Mark Johnson
Dr Payam Rezaie PHD
Prof Declan Murphy
RUNS
Runs & Marathons
Adidas Women's Challenge
BUPA 10K London
Great North Run
Reading Half Marathon
Royal Parks Half Marathon
BUPA 10K 2011
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AUTISTICA ARRANGED EVENTS
Autistica arranged events
Alnwick Garden Walk
Clay Shoot
Lunch 2010
HOW YOU CANHELP US
Ways you can help
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MAKE A DONATION
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