Charity Event Registration Form

200 Mile Charity Walk Registration Form

Fill out the form carefully for registration
All participates are required to submit a £20.00 donations which cover the cost of overnight accommodation and event up fees, please select yes/no if you are happy with this donation

YESNO
Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Mobile Number

Area CodePhone Number
Physical Restrictions / Health Information
Please select from the below dates in which you wish to particiapte, acoomidarion will be provided for each evening however please be aware this does not include any evening meals
Select Days

Tuesday 24th FebWednesday 25th FebThursday 26th FebFriday 27th FebSaturday 28th FebWill you require accommodation the night before event
Should be Empty:

200 Mile Charity Walk Registration Form