Registration Form: Have a Chat

Register Interest - Have a Chat Run

If you are interested in hosting a leg of the 'Have a Chat - Run with Jason' we'd love to hear from you. Hosting a run can be as simple as nominating a start/finish spot and encouraging people from your organisation along or as involved as hosting a fundraising event or booking Jason to host a speaking event.
Contact Person Name*
Email*
Phone*
Organisation*
Website (so we can acknowledge your support on our website and social channels):
Social Media Accounts (so we can acknowledge your support on our website and social channels):
Address*
Please select the date you would like to host a leg of the 'Have a Chat - Run with Jason'. If you are flexible with dates, you are welcome to select multiple options. *

Friday 4 October 2024Monday 7 October 2024Tuesday 8 October 2024Wednesday 9 October 2024Thursday 10 October 2024Friday 11 October 2024Saturday 12 October 2024Monday 14 October 2024Tuesday 15 October 2024Wednesday 16 October 2024Thursday 17 October 2024Friday 18 October 2024
What type of event are you considering running to coincide with hosting a leg of the 'Have a Chat - Run with Jason'?*
Do you have an event start time in mind? *
Would you be interested in having Jason speak at your event (for a fee of $750). You will also receive your logo on that day's running shirt as part of this offer.*

YesNoI'm interested to learn more (Jason will reach out and have a chat)
Would you like support to identify ways to promote and fundraise your event?*

YesNoI'm interested to learn more (Jason will reach out and have a chat)
Please upload a copy of your organisation logo for printing on the running shirt (included when you book Jason for a speaking event):*

Cancelof
Next Steps We will review your registration and confirm if your selected date(s) is available. We will then work with you to develop and promote your event. *

I understand
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Register Interest - Have a Chat Run