Royal Parks Application Form - Refuge Charity

Title*
First Name*
Surname*
Date of birth

Day
Month
Year
Email Address*
Contact Number*
Address
Address line 1 Address line 2 Town/City County Postcode Country
Please select your running vest size*
The sponsorship pledge for Refuge's Royal Parks places is £200. Please confirm that you understand this and agree to reach this target.*
- I confirm that I will raise the minimum of £200 if I am successful in getting a place on #TeamRefuge for the Royal Parks Half
Please tell us your reasons for wanting to support Refuge through this event:
Want to find out how you've made a difference?
We can only send you information on the impact of your fundraising - plus how you can work with us to change the lives of even more women and children through donating, fundraising, campaigning and volunteering - if you tell us how you'd like to be contacted.
I am happy to receive emails from Refuge*
- Yes, I am happy to receive emails from Refuge
- No, I do not want to receive emails from Refuge
I am happy to receive texts from Refuge*
- Yes, I am happy to receive texts from Refuge
- No, I do not want to receive texts from Refuge
If you would prefer not to receive calls or post from Refuge, please tick the relevant box below:
- I would prefer not to receive calls from Refuge.
- I would prefer not to receive post from Refuge.
Name
This field is for validation purposes and should be left unchanged.

Freephone 24-Hour National Domestic Abuse Helpline: 0808 2000 247
or visit www.nationaldahelpline.org.uk (access live chat Mon-Fri 3-10pm)