Guaranteed Team Entry Application Form

Cerebral Palsy Sport Guaranteed Team Entry Application Form Conti Thunder Run – 2016

Thank you for choosing to run the Conti Thunder Run for Cerebral Palsy Sport.

Please take a few moments to complete this application form, in block capitals, and return to Marianne Burchell, our Fundraising Officer, at the following address: Unit 5, Heathcoat Building Nottingham Science Park University Boulevard Nottingham NG7 2QJ

Please try and give us as much information as possible.

There is an entry fee payable on application of £100 and we would also ask you to pledge to raise a minimum of £2,300 in fundraising which would need to be with us by 24th August 2016. This fundraising target does exclude any Gift Aid claimed from funds raised.

Team Captain Details Other M Title X Mrs X Miss X Ms X (Please r state) First Surname Name Home Employer’s Name & Address Address

Postcode P ostcode Date of D D / M M / Y Y Y Y Occupation Birth Day Teleph Eve Telephone one Mobile Email

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Some employ ers will help with sponsor ship by ‘match ed giving’, whereb y they match, or part- YES X NO X match any funds that you raise. Does your employ er operate such a scheme ? Your fundraising experience If you have taken part in other fundraising activities please provide details below: Date Charity name Amount raised How did you raise this amount?

Where did you hear about fundraising for CP Sport? Previou s CP Sport Internet search X CP Sport website X CP Sport email X X event engine particip ant Conti Thunde X Through family/friend/colleague X Other r Run

Would you be happy for any photographs of you taken at the event to be used in YES X NO X future CP Sport publicity such as magazines/leaflets or our website?

How much do you pledge to raise for CP Sport in total (target £2,300)? £ Details of how you would raise this amount? Estimated £’s raised? 1.

If you have a link to CP Sport please give further details.

If there is something about your participation that would make a good media story (e.g. special birthday on the day or unusual occupation), please give further details.

Why do you want to run the Conti Thunder Run for Cerebral Palsy Sport?

Please indicate the size of running top you will need. Please enter the quantity you will need in each size. MALE Small Medium Large X-Large

FEMALE Small Medium Large X-Large

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Team membe r details Team membe r 1: Other M Title X Mrs X Miss X Ms X (Please r state) First Surname Name Mobile Email Team membe r 2: Other M Title X Mrs X Miss X Ms X (Please r state) First Surname Name Mobile Email Team membe r 3:

Other M Title X Mrs X Miss X Ms X (Please r state) First Surname Name Mobile Email Team membe r 4: Other M Title X Mrs X Miss X Ms X (Please r state) First Surname Name Mobile Email Team membe r 5: Other M Title X Mrs X Miss X Ms X (Please r state) First Surname Name Mobile Email Team membe r 6: Other M Title X Mrs X Miss X Ms X (Please r state) First Surname Name Mobile Email Team membe r 7: Other M Title X Mrs X Miss X Ms X (Please r state) First Surname Name Mobile Email

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Your declaration

Before submitting your application, please read through the full Terms and Conditions (overleaf) and sign the following declaration. By signing you agree to the Terms and Conditions overleaf.

I have read and agree to the full Terms and Conditions associated with the Guaranteed Place for CP Sport.

If offered a place, I confirm that I will pay the upfront non-refundable entry fee of £100 and pledge to raise a minimum sponsorship of £2,300 (exclusive of Gift Aid) for Cerebral Palsy Sport. I understand that I must submit the full £2,300 to Cerebral Palsy Sport by 24th August 2016, and that if I have not raised the full amount by this date I may be liable to cover the remaining sponsorship myself.

X Signed: Date: D D / M M / Y Y

Thank you for taking the time to complete this application form. We will acknowledge receipt of your form once it arrives in the office.

Next Steps: 1. Submit your application to [email protected] 2. We will review your application and let you know if you have been successful by 15th December 2015 3. If you are successful we will need £100 to secure your place within 2 weeks of being offered the place.

We never give your information to other organisations. Your details will be used by CP Sport. If you do not want to receive information about other ways to support CP Sport, tick here [ ] DPA Date re Notes c For ei Acknowledged Offer Accept v e d

Terms and Conditions

If offered a guaranteed place, I will pay a non-refundable registration fee of £100 and I commit to raise a minimum of £2,300. I understand that 100% of my sponsorship must be paid to CP Sport within 1 month of the event.

1. Participants agree to pay Cerebral Palsy Sport a non-refundable team registration fee to guarantee their entry.

2. Participants agree to raise the minimum sponsorship specified for the event. This is a condition of entry.

3. Participants agree that if they have not paid the minimum amount to Cerebral Palsy Sport by 24th August 2016 after completing the event will make up the shortfall themselves.

4. Participants agree to inform Cerebral Palsy Sport immediately if they are unable to take part in the event.

5. You must carry out your fundraising in accordance with guidelines set by Cerebral Palsy Sport.

6. Cerebral Palsy Sport cannot take any responsibility for any injury, losses or damage caused or sustained as a result of fundraising events held in aid of Cerebral Palsy Sport. It is the responsibility of the event organiser, to comply with legal and safety regulations.

7. Cerebral Palsy Sport may, at its discretion, withdraw a participant it believes that it is in the best interests of the charity to do so.

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