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Sunday 5th June 2011

Dear Weston Hospicecare, I’ve decided this looks like fun and I want in! Please enter me into the Weston Mercury Mendip Challenge on Sunday June 5th 2011. I agree to abide by the rules of the event and understand that participation is at my own risk and the organisers cannot be held responsible for any injury or loss incurred before, during or after the event. I agree to observe the Country Code at all times and understand that I must be finished by 8pm or earlier. I confirm I am taking part in the Mendip Challenge at my own risk and if I do suffer an injury or loss during the event Weston Hospicecare, The Weston & Somerset Mercury and any associate sponsors cannot be held responsible.

To take part in the Weston Mercury Mendip Challenge, please fill in the form on this page.

Please note: The entry fee only covers event costs and we rely solely on sponsorship to raise funds. All sponsorship to be received by 31st July 2011. Entry: Adult £6.00/Child £3.00 (Under 16) - which includes shoelaces, medal, map and a brilliant day out. Non refundable. Closing date 26th May 2011.

Name
Adult / Child
Address
Town
County
Postcode
Email Address
Daytime Phone
Mobile
Contact number in case of emergency
Which walk do you wish to participate in?
Please tick this box if you are planning on running the Weston Mercury Mendip Challenge.
(Please note the event is a walk so if running the check points may not be open).
It is important that Weston Hospicecare is aware of any health problems that
you suffer from that might require medical attention during the walk.
Please give details including any prescribed medication
If you are walking as a group, please enter the group's name
How did you hear about the walk?
Why have you chosen to take part in the walk?
Do you need a place on the free coach service from the Hospice in Uphill to your walk's starting point?
I am doing the EXTRA MILE (optional)
Please tick this box if you do not want to participate in any publicity
Please tick this box if you are under 18 years old
We would like to keep you informed about our fundraising and hospice activities. We will not disclose your details to any other organisation. Please tick this box if you would not like to receive further information after the event is complete.
 
Terms & Conditions
Registration fee
After you have registered you will receive a sponsorship pack which includes a sponsorship form, walk number and details about what happens on the day.
Your payment will appear on your bank statement as Miss You, any queries please phone 01934 423960