CRISIS LONDON MARATHON TEAM 2013
I accept the challenge to participate in the Flora London Marathon on 21st April 2013 as part of the Crisis team.
If I am offered a Golden Bond (guaranteed) place, I pledge to raise a minimum of £1,718 for Crisis (excluding
Gift Aid, but including company match funding if appropriate). In order to secure your place, please pay the
£18 of your pledge upfront which covers your registration and administration costs.
I understand that the Marathon place granted to me has cost the charity £300 plus VAT and that by starting the Marathon on 21
April 2013 using the Charity's place, I will be honour-bound to deliver the pledged amount whether from sponsorship or from my
own resources in the event of a shortfall. I further understand that I will be released from this pledge if I voluntarily surrender the
place to the charity before 8th February 2013. I agree to return all my sponsorship money to Crisis by the end of June 2013. I will
be over 18 on 21st April 2013.
Signed ______________________________________________________ Date_____________________
Daytime Tel: Mobile: (Tick here if you’re happy to hear from us by SMS text)
Date of birth: (Enter as dd/mm/yyyy) Male Female
Vest size: Small Medium Large Extra large
COMPANY INFORMATION (if applicable)
Company name: Type of Business:
Postcode: Job title:
I would like to pay my registration fee of £18 (£15 plus VAT): by Cheque (payable to Crisis UK) by Credit/Debit Card
I understand that my cheque will not be cashed / my card charged until my place is confirmed by Crisis. Thereafter, this fee is non-refundable in
the event of my withdrawal prior to the race or in the event of my getting my own place in the ballot. However, if I cannot run in 2013 and then
sign up for a Bond place in the 2013 Marathon, I will not be required to register again.
Card Type: MasterCard Visa Maestro Switch (please tick)
/ / / /
London Marathon 2013 Pledge Form Page 1
Switch issue no: / Start date / Expiry date: / Security No:
Name on card:
What is your personal fundraising target? £
How will you raise this amount?
(Please provide as much information as possible, as our
decision on whether we can offer you a place on the
team will be based on this information.)
Why do you want to fundraise for Crisis?
Have you supported Crisis in the past? Yes No (If yes, please give details below)
Details of previous support:
Have you ever run the London Marathon before? Yes No (If yes, please give details below)
Have you applied for your own place in the London Yes No
Please tell us how you found out about running the London Marathon on behalf of Crisis
Crisis would like to keep you informed about our events programme. If you would prefer NOT
to receive future information, please tick here.
Please tick here if you would like to receive regular e-mails about Crisis' projects and events.
Please complete both pages, print off this form, sign and return to Crisis Events Team by fax at 0844 251 0110 or by post
to Crisis, 66 Commercial Street, London E1 6LT. For any queries, please call us on 020 7036 2852.
We will let you know whether we can offer a place as soon as we can!
London Marathon 2013 Pledge Form Page 2