Together for Gaza Family route 2021 Registration form

Sign up to cycle from London to Whitstable with Penny Appeal and Medical Aid for Palestinians on October 16th, 2021 in aid of our Limb Reconstruction project in Gaza.

This is the registration for the family route of 12km - this selection admits one adult and one child (aged between 12-16).

* denotes required fields

Personal Details

Title *

First name *

Surname *

Other names

Prefer to be known as

Home address *

Town *

County

Postcode *

Country *

State *

Telephone number *

Mobile *

Email address *

Do you require a running vest or t-shirt? *

Size *

Date of birth *

Company name (if applicable)

Does your company operate a matched giving scheme?

Yes

How did you hear about MAP?

What motivates you to run for MAP?

We would like to keep you updated on the latest from our programmes, campaigns, fundraising activities, and appeals by email*

Yes

If you are currently subscribed to our email list, you can unsubscribe by clicking the link in the footer of the email.

Declaration

By completing this form, I confirm that I agree to the following declaration - I would like to participate in the Together For Gaza event for MAP and Penny Appeal and pledge to raise a minimum of £200 (excluding Gift Aid) which will be paid no later than 4 weeks after the event. I understand the registration fee of £15 is non-refundable. I understand that this registration admits either myself, or myself and one child for which I will need to complete a registration form for that will be sent to me by MAP once I have completed my registration. I hereby confirm that I will be 18 years old (on the day of the event) and that the child I intend to participate with will be between the ages of 12-17 on the day of the event.

Please tick here to indicate that you agree to the Declaration above *