Virtual London Marathon 2021 Registration form

* 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 Virtual London Marathon for MAP and pledge to raise a minimum of £500 (excluding Gift Aid) which will be paid to MAP no later than 4 weeks after the event. I understand the registration fee of £27 is non-refundable. I hereby confirm that I will be 18 years old (on the day of the event) and acknowledge that I am taking part in this event entirely at my own risk. I therefore do not hold MAP responsible for any injury or loss that might occur as a result of my participation.

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