Epilepsy Research UK - support us - do an event for Epilepsy Research UK

Support us - Do an event for Epilepsy Research UK

Please complete this form if you would like to run or do an event on our behalf:

Your details
Name
Mr/Dr/Ms/etc
Address
Phone (day)
Email

Race details
I want to take part in:
	Big Fun Run 2010 (Please indicate the race you wish to enter, in the 'Your commitment' box below)
	Mazda London Triathlon 2010 07/08/10-08/08/10
	Adidas Women's 5K Challenge 2010 05/09/10
	Bupa Great North Run 2010 19/09/10
	Bupa Great South Run 2010 24/10/10
	Virgin London Marathon 2011 24/04/11 (tbc)
	Other. Please specify:


I want to do a skydive for Epilepsy Research UK

My vest/T-shirt size is:
	S	M	L	XL
	XXL

A minimum sponsorship target applies to guaranteed charity entry. The amount varies with the event. There is no minimum sponsorship target for independent entry.


Your commitment
Why do you want to fundraise for Epilepsy Research UK?

Would you like to raise money in memory of a particular person? Please give their full name:


Occupation

How did you hear about us?
	London Marathon website
	Great Run website
	Google or other search engine
	Other. Please specify:


Please tick if you do not wish to receive our
	e-newsletter (monthly)
	Focus newsletter (3 issues per year)

Thank you for your interest in supporting epilepsy research!