Virgin London Marathon Application Form 2018 Thank you for your interest in running for Medical Detection Dogs in the 2018 London Marathon on 22 nd April 2018 by fundraising for us. Every made will help us to save and change lives! Before you complete this form please ensure that you have read through the terms and conditions. In order to run in this event, you will need to be able to raise a minimum of 2000. Please complete and return this application by 5pm on Friday 29 th September 2017 to: POST: EMAIL: Fundraising, Medical Detection Dogs, 3 Millfield, Greenway Business Park, Winslow Road, Great Horwood, Milton Keynes, MK17 0NP Challengeevents@medicaldetectiondogs.org.uk TEL: 01296 655888
Application form Your details Full Name: Gender: Male / Female Date of birth: / / Email: Telephone: Twitter handle: Occupation: Employer: Your address Address 1: Address 2: City /Town: County: Country: Postcode: Marathon Running Experience Have you applied for a 2018 place through the official London Marathon Ballot System? Yes/ No Do you currently run regularly? Have you ever run a marathon before? Yes / No Yes / No If yes, please advise if previous marathons have been in support of charity, which one(s) and how much you raised:
Additional information I would like to run the London Marathon for Medical Detection Dogs because. (Please continue on extra sheets if necessary) Fundraising How much do you expect to raise in sponsorship? Please note: our minimum sponsorship requirement is 2,000 excluding Gift Aid. How do you plan to raise this sponsorship? Please give details of previous fundraising experience. Does your employer run a matched giving scheme? Yes / No / Don t Know If yes, please provide details. T-Shirt Size: Small / Medium / Large / Extra Large
Other Please give any other information you feel relevant to your application: Data Protection We will hold data you have provided for administrative purposes and to keep you informed of our fundraising and other activities. We are committed to protecting and respecting the privacy of our supporters, promising to keep secure any information we hold and never to sell personal data to any third party. We hope that you will want to receive such information, whether you are successful or not in securing one of our places. Please tick the relevant box(es) below to let us know how you would prefer to be kept informed and what you would like to hear about: by email by post Fundraising, news and campaigns Research To change your preferences or unsubscribe at any time, you can either contact us by email at fundraising@medicaldetectiondogs.org.uk or call us on 01296 65588. Marathon Pledge I am applying for the Medical Detection Dogs charity ballot place for the 2018 London Marathon. I understand that if I am successful in being offered the place I am undertaking to raise a minimum of 2000, excluding Gift Aid for Medical Detection Dogs. Signed: Date:
Terms and Conditions By completing an application for a Medical Detection Dog place in the London Marathon you agree to the following Terms and Conditions. 1. If you are allocated the Medical Detection Dogs Charity place, then you must agree to only fundraise for Medical Detection Dogs. The easiest way to do this is to set up a Virgin Money Giving page. 2. You agree to a fundraising deadline of 3 months after the event date. You pledge to raise 2000 (excluding Gift Aid). 3. If your application is successful, Medical Detection Dogs will notify you by email. 4. Any regular donations which you make to Medical Detection Dogs do not form part of the total raised through sponsorship. 5. Any monies raised under the Gift Aid scheme do not count towards the total value of sponsorship raised. 6. All Medical Detection Dog runners agree that image, audio and video taken on the day may be used by Medical Detection Dogs to promote its events in the future. 7. By submitting this application form to Medical Detection Dogs. It is deemed that you have read and accepted the above terms and conditions. Applications forms should be completed and submitted to: Francesca Hockham, Medical Detection Dogs, 3 Millfield, Greenway Business Park, Winslow Road, Great Horwood, Milton Keynes, MK17 0NP or emailed to challengeevents@medicaldetectiondogs.org.uk