London Bridges WalkRegister 1 2 3 4 5 In aid of Event Date: 9 May 2021 Registration Fees Adult - £15.00 Children 16 years & under - £10.00 Corporate team of 5 - £60.00About YouWhich distance are you walking?*6.5 miles13 milesWhich charity are you walking for?* The Griffin Institute St Mark’s Hospital Foundation Both charities Name* Dr.MissMr.Mrs.Ms.Prof.Rev.Other. Prefix First Last Prefix. if OtherDate of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Email* Phone*Address Street Address Town or City Post Code T-shirt size*SmallMediumLargeXLXXL Entering a Team or Company?Team or Company Additional Participants Actions Edit Delete There are no Team Members. Add Team Member Maximum number of team members reached. Emergency Contact DetailsThis must be someone NOT taking part in the event.Name* Dr.MissMr.Mrs.Ms.Prof.Rev.Other. Prefix First Last Prefix. if OtherContact Number*Relationship to main registrant / Team leader* Additional DetailsHow did you hear about the event?*FlyerPosterFacebookLinkedInTwitterWebsiteFriends or familyOtherIf other please tell us where you heard about the event here.Photography*Photographs I appear in during the event can be used by The Griffin Institute and St Mark’s Hospital Foundation for publicity and marketing purposes.YesNoKeeping in Touch / Data protectionWe would like to keep in contact about upcoming news, events and fundraising activities using the contact details you have supplied. The Griffin Institute and St Mark’s Hospital Foundation value your support and privacy, we will not share your details with any third party organisation. Please tell us which communications you would like to receive from us. If you select none, we will not contact you. Select All Newsletter / updates Fundraising events Opportunities to donate Please tell us how you would like to receive this information (please tick as many boxes as you like) Select All Email Post Telephone Text / SMS Leaving a gift in my WillI would like to know more about leaving a gift in my Will. Yes No Leaving a gift in my WillPlease tell us how you would like to receive this information (please tick as many boxes as you like) Select All Email Post Telephone Text / SMS Privacy and Terms & Conditions*You can unsubscribe at any time by emailing: info@griffininstitute.org.uk or info@stmarkshospitalfoundation.org.uk. For more details about the way we use your information, please see the privacy policies on our websites. Terms & Conditions I agree to the terms and conditions PaymentRegistration Fees Adult - £15.00 Children 16 years & under - £10.00 Corporate team of 5 - £60.00 ‘Please enter the number of participants (Adults and Children) or the number of Corporate teams of up to 5 participants.Adult Price: £ 15.00 Quantity: Children Price: £ 10.00 Quantity: Corporate Team Price: £ 60.00 Quantity: Total £ 0.00 Payment Method* Card Details Cardholder Name Please Enter Your Card Details
