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Walk for Life
10.05.15
H
Regi urry!
closestration
s 29
Apri th
l!
Get your walking boots on
and help support local families
affected by life limiting
illnesses. Pre-register Supported by:
now to ‘Walk for Life’
for Farleigh Hospice.
Register now at:
www.farleighhospice.org/walkforlife
[email protected]
01245 457408
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Charity Registration no 284670
29/12/2014 15:06:18
The 23rd annual
Walk for Life for
Farleigh Hospice
Sunday 10th May 2015!
Don your walking boots and join us for a leisurely, canalside stroll! There are two scenic routes to choose from:
23km walk from Heybridge to Chelmsford
10.5km walk from Paper Mill Lock to Chelmsford
So - whatever your age and ability - you can ‘Walk for Life’ for
Farleigh Hospice!
There is a £10 registration fee for adult walkers and a £5 fee
for children under 16 (must be accompanied by an adult) which
goes towards the cost of a T-shirt and overall administration
of the event. As the two routes are not circular, coaches will
be available from Chelmsford to take you to the start of your
chosen walk.
For further information and to register:
● visit www.farleighhospice.org/walkforlife today, or
● complete and return the attached form.
The ‘Walk for Life’ is a sponsored event. Farleigh Hospice relies on
walkers raising as much money as possible towards their caring work
in the local community. The sponsorship money raised by this event
will be transformed into specialist care that makes a real difference to
local families affected by life limiting illnesses.
Hurry! Pre-registration closes Weds 29th April!
Yes, I would like to Walk for Life for Farleigh Hospice
Main Walker
Title _______ Full Name _________________________________________
Please help keep our costs low. If you are happy to receive communications by email and text please
give your email address and mobile number:
Email
__________________________________________________
Mobile __________________________________________________
Address __________________________________________________
___________________________Postcode _______________
Home Phone ___________________________DoB __________________
Do you have a special reason for taking part? Y / N (delete as applicable)
If yes, what is it? ________________________________________________
________________________________________________
________________________________________________
If you would prefer NOT to share your story to help us publicise the event
please tick here £
Route: £ 23km
£ 10.5km (tick one)
T-shirt size: £ S £ M £ L £ XL £ No T-shirt required (tick one)
Coach: I do £/do not £ require a coach seat to take me from e2v in Chelmsford.
£ I have not used
before, please set up a fundraising page for me
(We will use the email address given above for your fundraising page)
Additional Walkers
Title _______ Full Name _________________________________________
Please help keep our costs low. If you are happy to receive communications by email and text please
give your email address and mobile number:
Email
__________________________________________________
Mobile __________________________________________________
Address __________________________________________________
___________________________Postcode _______________
Home Phone ___________________________DoB __________________
Route: £ 23km
£ 10.5km (tick one)
T-shirt size: £ S £ M £ L £ XL £ No T-shirt required (tick one)
Coach: I do £/do not £ require a coach seat to take me from e2v in Chelmsford.
£ I have not used
before, please set up a fundraising page for me
(We will use the email address given above for your fundraising page)
Title _______ Full Name _________________________________________
Please help keep our costs low. If you are happy to receive communications by email and text please
give your email address and mobile number:
Email
__________________________________________________
Mobile __________________________________________________
Address __________________________________________________
___________________________Postcode _______________
Home Phone ___________________________DoB __________________
Route: £ 23km
£ 10.5km (tick one)
T-shirt size: £ S £ M £ L £ XL £ No T-shirt required (tick one))
Coach: I do £/do not £ require a coach seat to take me from e2v in Chelmsford.
£ I have not used
before, please set up a fundraising page for me
(We will use the email address given above for your fundraising page)
PLEASE TURN OVER TO COMPLETE YOUR REGISTRATION ►►►►►►►
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Title _______ Full Name _________________________________________
Please help keep our costs low. If you are happy to receive communications by email and text please
give your email address and mobile number:
Email
__________________________________________________
Mobile __________________________________________________
Address __________________________________________________
___________________________Postcode _______________
Home Phone ___________________________DoB __________________
Route: £ 23km
£ 10.5km (tick one)
T-shirt size: £ S £ M £ L £ XL £ No T-shirt required (tick one))
Coach: I do £/do not £ require a coach seat to take me from e2v in Chelmsford.
£ I have not used
before, please set up a fundraising page for me
(We will use the email address given above for your fundraising page)
To register more walkers please continue on a separate sheet
If you are registering as part of a team, what is your team name?
__________________________________________________________
Payment Details
Total Number of adult walkers x £10 = £
Total Number of child (U16) walkers x £5 =£
1. I enclose a cheque for £
(please make cheques payable to Farleigh Hospice)
2. Please debit £
£ Visa
£ Mastercard
from my
£ Maestro
£ Delta (please tick one box)
Name ____________________________________________________
Card No
££££ ££££ ££££ ££££
3-Digit Security Code £££ Issue Number (if applicable) ££
Valid from ££/££ Expiry Date££/££
Signature ___________________________Date ________________
Please return your form to FREEPOST RRLJ-BKTZ-ACEH,
Farleigh Hospice, North Court Road, CHELMSFORD CM1 7FH
If you would like to find out about other ways you can help, please tick a
box below for more details:
£ Sponsor a Nurse
£ Join the
£ Leave a gift in your Will £ London Marathon
£ Volunteering £ Run my own fundraising event
In accordance with the Data Protection Act all information will be stored securely.
We will NOT pass your details to a third party for marketing purposes but we would
like to keep you up to date with the difference your support is making and will send
you occasional information which we think will be of interest. If you do not wish to
receive this information please tick here. £
Charity registration no. 284670
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