For office use only CARE No Region Virgin Money London Marathon – Sunday 24 April 2016 Golden Bond place application To be considered for one of the Cystic Fibrosis Trust’s Golden Bond places, please complete both sides of this form as fully as possible. Detailed answers will enhance your application. The public ballot entry system for the 2016 Virgin Money London Marathon will open to all applicants on bank holiday Monday 4 May 2015. This ballot system will close at 5pm on Friday 8 May 2015. To increase your chances of gaining a place in the 2016 Virgin Money London Marathon please also apply to the ballot at www.virginmoneylondonmarathon.com. Title First name Mr/Mrs/Ms/Miss/Other (please state) – circle as appropriate Surname Address Postcode Phone (home) Phone (work) Phone (mobile) Email *Date of birth Occupation Employer How much sponsorship do you aim to raise? Remember, we ask for a minimum pledge of £2,016. Please tell us how you aim to raise this sponsorship (eg, work, family, friends, local press, organising events, company matching) Please use this to start drafting your fundraising plan now! Why do you want to run for ‘Team CF’? If you have a link to someone with CF please tell us their name(s) and how you know them. *Please note that you must be at least 18 years old on 24 April 2016 to participate in the London Marathon. continued over... Have you undertaken any other fundraising for the Cystic Fibrosis Trust before? If so please tell us what you did, and how much you raised. Are there other ways you may be able to support the Cystic Fibrosis Trust, eg, do you have a good story you’d be happy to speak to the media about, or other fundraising plans? Does your employer have a ‘Charity of the Year’ we could be nominated for etc.? Have you run a 10k, half or full marathon before? If yes, which one(s) and when? Have you run a 10k, half or full marathon for the Cystic Fibrosis Trust before? If yes, which one(s), when and how much did you raise? Have you applied to the ballot? Yes / No (please delete as appropriate) Team CF running top T Shirt If no, please ensure you apply on Tuesday 22 April 2016 and select the Cystic Fibrosis Trust as your preferred charity. It will close in a matter of hours, so set your timer! Running vest (please tick the top you would like) S / M / L / XL / XXL (please circle the size you would like) You may also be able to get a place via your running club or Good for Age scheme – please see www.virginmoneylondonmarathon.com for details Your declaration to the Cystic Fibrosis Trust: I understand that if accepted for a Cystic Fibrosis Trust Golden Bond place I am undertaking a pledge to raise a minimum of £2,016. The money will be paid to Cystic Fibrosis Trust no later than 31 May 2016. Signature:____________________________________________Date:______________________ Now simply return this form as soon as possible to: [email protected] or post to: VMLM 2016, Cystic Fibrosis Trust, 2nd Floor, One Aldgate, London EC3N 1RE Ballot results are released early October so good luck and please let us know if you get one. Our Golden Bond places are allocated at this time, and we also aim to contact you with the result of this application in October. Protecting your personal information: We promise that any information you give us will be used by the Cystic Fibrosis Trust only. By giving us your contact details, you consent to us keeping in touch (including telephone) to let you know about the Cystic Fibrosis Trust’s activities, including fundraising, and how your support is making a difference. If you would rather not hear from us then please let us know. The participant consents that his/her appearance in the event may be filmed/photographed for possible use by the Cystic Fibrosis Trust for online and printed publicity materials. Please see cysticfibrosis.org.uk/privacypolicy for details of our Privacy Policy. © Cystic Fibrosis Trust 2015. Registered as a charity in England and Wales (1079049) and in Scotland (SC040196). A company limited by guarantee, registered in England and Wales number 3880213. Registered office: Cystic Fibrosis Trust, 2nd Floor, One Aldgate, London EC3N 1RE