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Golden Bond Application Form
Bupa London 10,000 2015
Fight for Sight holds a number of Golden Bond (guaranteed) places for the Bupa
London 10,000 on Monday 25 May 2015.
We ask that all runners who successfully secure one of our places pay a £25 entry fee
per person and pledge to raise a minimum of £250 for Fight for Sight. If you feel you
are able to raise this amount, and would like to be considered for a place, please
complete this form and email it to [email protected] or send it to Fight for
Sight, 5th floor, 9-13 Fenchurch Buildings, Fenchurch Street, London EC3M 5HR.
Your details:
Title:
First name:
Surname:
Address:
Postcode
D.O.B:
Daytime contact no:
T Shirt/Vest Size: small/medium/large/xlarge
(please circle)
Mobile tel no:
Email:
Occupation:
Name of employer:
Have you taken part in any running events before?
Yes

No
If YES what is the longest distance you have covered?
Have you supported Fight for Sight before?
Yes
No
If NO please let us know how you heard about Fight for Sight.
How much do you think you can raise?
Does your employer match fund?
Yes
No
Please let us know why you would like to run for Fight for Sight in the Bupa 10,000
2015:
Please outline ways in which you will raise the minimum pledge of £250 for
Fight for Sight
Entry Payment Details
£25 per place
 I enclose a cheque for £…………payable to Fight for Sight
 I wish to pay £….. by card (Visa, Delta, Mastercard, Switch or Maestro only)
Card No: _ _ _ _
____ ____
____
Secuirty No: _ _ _
(last 3 digits on the signature strip)
Issue Date: _ _/ _ _ Expiry Date: _ _ /_ _
Issue No: _ _ (Maestro and Switch Only)
Name on Card: ……………………………………………………………
Cardholder’s Address (if different from above)
Address: ……………………………………………………..
………………………………………………………………….
……………………………………………..Postcode:…………….
Signature:…………………………………………….
Date:……………………………………………………
Your declaration:
I pledge to raise a minimum £250 for Fight for Sight in return for a place in the Bupa
London 10,000.
I understand that any money raised by my sponsors will be transferred to Fight for Sight
without undue delay. I also understand that by applying for a Fight for Sight place our
Communications Officer may contact me with regards to placing a story on the Fight for
Sight website and in local newspapers.
Signature (or print name) of applicant:……………………………….Date: …………………
Thank you for taking the time to complete this form. Please return the form to
[email protected]. Alternatively post the form to Events team at Fight for
Sight, 5th Floor, 9-13 Fenchurch Buildings, Fenchurch Street, London EC3M 5HR.