THc Running Application

Emergency contact on Day
	Title
	First Name *
	Surname *
	Company Name
	Address Line 1
	Address Line 2
	Town
	County
	Post Code
	Daytime Tel No

	Email Address
	Post Code
	Name of contact *
	Tel No. of Contact *
Choice of run
	Have you already secured a place in a running event?	Yes No
	Please indicate your chosen running event	British 10k Ladies 8k Windsor Half Other
	If you have ticked "other" because you have confirmed a place in an alternative event please give details
	How did you hear about the THc running programme?
	Do you suffer any health problems that might require medical attention during the run?	Yes No
	If yes, please state including any prescribed medication
	I understand if I am in any doubt about my health or have a medical condition that may be affected by exercise, I should obtain my doctor's approval before participation *
	Your FREE running vest	Small Medium Large Extra Large
Fundraising Pledge
	I understand this is a fundraising event and pledge to raise as much money sponsorship as possible and in the event that I am unable to raise sponsorship and have used a Thames Hospicecare space, I agree to pay the entry fee that THc have incurred *

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