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Event Registration

Event Details:

Event:*
Date:*
Location:*
Estimated Income:*
Approx. no. of Participants:
Additional Information:
Registering:*

Your Details:

Title:*
First Name:*
Last Name:*
House Name or Number:
Address:
Town:
Postcode:
Phone*
Mobile
Email Address*
Repeat Email Address*
Date of Birth*

Business / Organisation Details (if applicable):

Business / Organisation Name:
Your Role / Title
Potential Number of Volunteers
Business Address:
Town:
Postcode:
Main Phone Number

Fundraising Materials:

We can provide you with a selection of the following fundraising materials to help with your event but in order that we minimise costs, supplies are limited

Item	Number Required
Balloons (max 10):
Collections Buckets (max 4):
Collection Tins (max 4):
Company-specific Paying-in forms:
Gift Aid Forms:
Posters (max 10):
Regular Giving Forms:
Sponsorship forms (25 entries per sheet):

NB: To protect you and the hospital from accusations of fraud, all sponsorships forms used and unused must be returned for auditing purposes.

Your Donation:

If you wish to specify a ward / department / fundraising appeal for your proceeds to be donated towards please let us know

I would like to donate the proceeds of this event towards:

Our supporters:

Please take a few minutes to tell us about yourself. You do not need to supply this information but it helps us to understand who our supporters are.


Have your children been treated in the hospital?	Yes
What department / services have they used?
Has another child relative or friend's child been treated at the hospital?
What is your occupation:	Full-time worker Part-time worker Professional Retired Not working / carer
What are your interests?	Cycling Running Walking The Arts / Music	Golf Family Outings High-Adrenalin Sports Adventurous Travel

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Declaration:

I agree to donate all the proceeds from the above event to Birmingham Children's Hospital Charities. Under no circumstances will I divert any money raised in this name to any other organisation or individual, without the full knowledge and consent of Birmingham Children's Hospital Charities

After this event we'd be delighted to keep you updated. Please tick here to give your consent.

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