Midnight Walk Registration

Required donation: £10

Register now for the Midnight Walk ! The 10km sponsored stroll is open to ladies and accompanied female children over the age of 12. Closing date for registration is Friday 8th June 2012.

Personal information

Title:

First Name:

Surname:

Address:

* *

Postcode:

Telephone:

Email:

Additional information

Date of birth (if under 18)

Emergency contact tel no.*

Why have you chosen to take part?*

Where did you hear about the Midnight Walk?*

Please select your T-shirt size

S (34"/36")
M (38"/40")
L (42"/44")
XL (46"/48)

I would like to be kept updated of St Cuthbert’s Hospice news and events via email
I would like to be kept updated of St Cuthbert’s Hospice news and events via post

I agree to the outlined terms and conditions

Thank you. Your support touches lives.

* indicates a required field.