User Agreement and Signature Form
Please review the terms and conditions, then sign to confirm your agreement.
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: 00000-000000.
Signature
*
Date of Signature
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Does your employer provide match giving ( where your employer will match the amount you fundraise) ?
Please choose what size Llys Nini Branded Running Vest you require.
Small
Medium
Large
X Large
XX Large
If you're happy to share your story with our press team to help us promote the work of the charity in the future please share it with us:
I agree to photography or video/audio recordings of me being taken for use in RSPCA Llys Nini publications and the media, to promote the work of the RSPCA Llys Nini.
Yes
No
Agree and Submit
Should be Empty: