Run the Flora London Marathon 2006 for the Evelina Childrens

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Run to the Beat Sunday 5th October 2008
raising money for the health of our children
Registered charity number 251983-21

If you would like to be considered as a replacement for a runner that has dropped out please complete this
form. Please note: It is worth considering the fundraising section very carefully as our places are
allocated on the basis of your fundraising plans, not at a random or on a first come first served basis.
Please complete and return this form by 2pm Thursday 14th August 2008 along with your deposit of
£25. You are required to raise a further minimum of £200.

Personal Details

Full name:

Home Address:

Postcode:                                           _       Date of birth      ____________________

Daytime Tel:                                 Eve tel: _____________ Mobile:

E mail:

Please tick if you are happy for us to contact you by e-mail. This helps reduce our costs

Occupation:                                                 Company:

Does your place of work provide matched giving for the sponsorship you raise? Yes/ No

Entry information

Why do you want to run for The Evelina Children's Hospital Appeal?

Do you have a link with the Evelina Children’s Hospital and/or Guy’s and St Thomas’ NHS Foundation Trust?
If so, please give details

How did you hear about the Team Evelina Run to the Beat places?
Fundraising information

Have you taken part in a half marathon/marathon before? Yes            No

If yes, did you raise money for charity? Yes     No    Were you running on a guaranteed place? Yes        No

Name of charity ________________________________                Amount you raised £

If no, have you raised money for a charity before? If, yes please give details


We ask that guaranteed place runners pledge to raise at least £200. Detail below how you plan to raise the
money listing more than one method. Please continue on separate sheet if necessary

We ask that our runners wear our charity t-shirt our running vest on the day. Please state which you would
prefer and your size        Running Vest               T-shirt          Size: S M L XL

I agree for my photograph or story to be used for publicity purposes        Yes   No

    I understand that if I am accepted for an Evelina Children’s Hospital Appeal Guaranteed place I am
      undertaking a pledge to raise a minimum amount of £200 to be collected by 13th December 2008
    I declare that to the best of my knowledge I am in a good state of health and take full responsibility for

Signature _______________________________________                  Date ________________________

What happens next

We will assess each application on basis of merit (based on past fundraising and fitness levels). We will then
let the successful applicant know that they have secured the place by Friday 15th August 2008.

                                               GOOD LUCK!

 Please return this form to Shadia Hameed, The Evelina Children’s Hospital Appeal, 1st Floor,
            Counting House, Guy’s Hospital, St Thomas’ Street, London, SE1 9RT

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