Run the Great Birmginham Run for Birmingham Children's Hospital

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Register NOW to run the 2012 Bupa Great Birmingham Run (formally the Birmingham Half Marathon) for Birmingham Children's Hospital

Event Details:

Event:*
Date:*
Location:*
Estimated Income:*

Your Details:

Title:*
First Name:*
Last Name:*
House Name or Number:*
Address:*
Town:*
Postcode:*
Phone*
Mobile
Email Address*
Repeat Email Address*
Date of Birth*
How did you hear about us?

Business / Organisation Details (if applicable):

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

Your Vest and Sponsorship Form:

We will provide you with a Birmingham Children's Hospital Vest and sponsorship forms if required. You can also set up a sponsorship page at www.justgiving.com

Your vest size:
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:

Please let us know what ward / department / fundraising appeal for your proceeds to be donated towards:

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

About You:

Do you have a connection to the hospital, e.g. family member treated here? If so please enter a summary of your story here if you happy to share your story for promotion of this event with the fundraising team?

Anti-spam check:

Please enter the text you see in the image:

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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.

Please note that you must register directly with the Great Birmingham Run to book your place .

I have already registered at www.birminghamhalfmarathon.com/

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Register NOW to run the 2012 Bupa Great Birmingham Run (formally the Birmingham Half Marathon) for Birmingham Children's Hospital

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