North2South Walk Start at the Public Car Park on La Rue des Platons (near junction with B63 and C97) from 8.30 am Finish at Gorey Coast Road Car Park (approx. 8 miles of mostly Green Lanes and beautiful countryside) Sunday 3 May 2015 Help us to raise funds for our £25,000 Awareness Campaign to encourage residents at risk of contracting diabetes to have their blood sugar levels tested so that the condition can be found early and treated successfully. Late detection can cause chronic medical conditions. Every penny of sponsorship (in addition to your registration fee) will help us towards this target. ------------------------------------------------------------------------------------------------------------------------------------------- REGISTRATION FORM: Please complete in block letters - only one entrant per form. Name (s)…………………………………………………..…………………………..…………………….................................. Address:…..…………………………………………………………………………………….………...............................….... Post Code:…….......Home Tel No: ……….......Mobile Tel No: ……........………...e-mail:................................................ DECLARATION - PLEASE READ AND SIGN BELOW: Please register me for the Diabetes Jersey – North2South Walk on Sunday 3 May 2015. I, the undersigned, agree to abide by the rules of the event. I understand that participation is at my own risk and the organisers cannot be held responsible for any injury or loss incurred before, during or after the event. I also agree to observe the Country Code at all times. I agree that all moneys I raise in sponsorship will be donated to Diabetes Jersey. THIS DECLARATION MUST BE SIGNED Signature of entrant: …………………………..…………………................................................................. Age of entrant if under 16 years of age on 3 May 2015 (who must be accompanied by a person over that age):….... Signature of Parent or Guardian if entrant is under 16 years of age:………………………………....................... For a N2S T-shirt (cost included in registration fee and available at the start of the walk) please indicate your size: SMALL / MEDIUM / LARGE / XLARGE / XXLARGE Please send the completed, and signed, form with your cheque for £10 for registration (£20 on the day) (payable to DIABETES JERSEY) as soon as possible to: North2South Walk, c/o Ms Katherine Toudic, 19 Alton Gardens, Rouge Bouillon, St. Helier, JE2 3ZD email: [email protected] Please tick the relevant A FREE TANTIVY COACH SERVICE WILL BE PROVIDED LEAVING THE STEAM CLOCK AT 8AM AND 8.30AM box if required A FREE TANTIVY COACH SERVICE WILL BE PROVIDED LEAVING THE PUBLIC CAR PARK AT GOREY (FINISH) AT 8.15AM AND 8.45 AM (LEAVE YOUR CAR AT THE FINISH)