Challenge event sign-up form

Full name*

 

Email*

Phone

 

Date of Birth

 

Which challenge event(s) are you interested in?
Event*

 

Do you already have your own place, or do you need a charity place?
Own placeNeed a charity place
 

Have you taken part in any Challenge Events before?
Yes (please provide details)No
Details of any previous events

 

Are you signing up as an individual or part of a team?
IndividualTeam
If team, please provide the team's name:

 

Would you like to combine your fundraising target with others (team-based fundraising)?
YesNoNot sure yet
 

What motivates you to do this event for Grassroots Suicide Prevention?

 

Link to your Facebook profile so we can add you to our online community

 

Are you running in memory of someone?
YesNo
If yes, would you like to share their name and your connection to them? (This information will help us support you and, if you wish, we can include it in our communication with you and honor your loved one by sharing their name in our updates, fundraising materials, and event acknowledgments.)

 

Would you be willing for your photos/videos to be used in our marketing?
YesNo
Comment:

 

Would you be willing to share your story or reasons for participating in this event to help raise awareness for Grassroots?
YesNo
 

Would you like to receive a Grassroots branded running t-shirt or vest (requires a minimum fundraising commitment of £75 each)?
T-shirtVestCycling JerseyDo not require
 

What is your preferred size?
XSSMLXLXXL
 

Address: (We will use this to post out your t-shirt/vest/jersey)

 

How did you hear about this challenge event?
Social MediaEmailWord of mouthGrassroots WebsiteOther (please specify)
If other, please provide details:

 

Any additional questions or information you'd like to share with us?

 

Please tick the box if you’d like us to update you with our upcoming free training courses, events and runners' news.

Please read the following and tick the box to agree:
 

Grassroots Suicide Prevention can use my information to contact me.