Registration Form 2021
Please note all our return correspondence to you will be via e-mail, and you will receive an e-mail copy of your completed form.
Address Line 1
Address Line 2
Town / City
Your age on 26/6/21 (necessary for race category)
For the purposes of the race category, please tell us your gender
There are two registration payment options; you can either pay a £10 registration fee when submitting this form, or alternatively pledge to fund-raise £100 for The Bridgend Centre via our Just Giving page. Please let us know which you agree to:
I agree to pay a £10 registration fee with this form, or
I pledge to fund-raise £100 for The Bridgend Centre via Just Giving
Option 1: Race Registration Fee
( X )
Pay Registration Fee
Race registration fee for one entrant, payable via Paypal / Debit / Credit Card
Option 2: Fundraising via Just Giving
Please click the image to open and publish your fundraising page
If you have this set-up, please let us know your Just Giving fundraising page address
Please note you can let us know by e-mail at a later date, and we will list your page in our publicity.
Is there any additional information you'd like us to know?
Terms and Conditions
Would you like to receive regular updates by email about the Bridgend Centre and the work we do in Bollington?
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