Register for the Vitality London 10,000

Please complete and submit the form below to register for a place on #TeamRefuge for the Vitality London 10,000.



First name


Date of birth


Address line 1

Address line 2

Address line 3



Contact number

Email address*

*In order to keep our costs down, we will contact you by email with important information and updates about this event.

Company name/town

Job role

Will your employer support your fundraising efforts?

If so, how?

Have you previously raised funds for Refuge?

If yes, please give details

What size running vest would you like?

Please share with us your reasons for taking part

How did you hear about Refuge's team places for this event?
TwitterFacebookGoogle searchEmailWord of mouthOther

If 'other', please give details

From time to time, we would like to send you updates about the life-saving and life-changing work with women and children you are helping to support and information about other ways you can get involved. We will NEVER share or sell your data.
I would like to receive updates from Refuge by post
I would like to receive updates from Refuge by email
I would like to receive updates from Refuge by phone
I have donated to Refuge previously - please use my existing communication preferences
I would not like to receive updates from Refuge


By submitting this application, you are declaring yourself medically fit to take part in this event.

If you have any injuries and/or medical conditions that could affect your participation, you should consult your GP and declare those conditions below