Walk Registration Form

All persons, irrespective of age, can participate in this Walk. Persons aged 18 years and over must register for the event. Persons under the age of 18 years are not required to register for the event, but must be accompanied by a registered adult.

1. Personal Details

Name*

First Last

Email*

Address

Street Address Address Line 2 City County Postcode / Eircode Country

Mobile Phone*

Telephone

Lead Contact

If you are participating as part of a family / group / organisation and there is a lead contact person, please provide his/her name:

First Last

2. T-Shirts

Please choose ONE of the following options in the section below:

NONE: I already have a T-shirt
NON-PERSONALISED: I would like a new non-personalised T-shirt
PERSONALISED: I would like a new personalised T-shirt.

T-Shirt Option*

NONE
NON-PERSONALISED
PERSONALISED

Name to be printed on T-Shirt

I’m walking in memory of

Confirm name to be printed on T-Shirt

Please confirm the name to be printed on the T-Shirt to ensure no errors.

T-Shirt Size*

Please indicate your T-shirt size (Adult sizes only):

Small
Medium
Large
X-Large

T-Shirt Delivery/Collection

I will collect my T-shirt from the hospice office in Knock
Please post my T-shirt to me
I will collect my t-shirt on the day of the walk in Knock

3. Sponsorship Cards

Sponsorship Cards*

How many Sponsorship cards would you like?

Setup-iDonate

Please tick this box to have an iDonate fundraising page set up for you.

Setup my Crowd Funding Page

4. Keeping in Touch

Keeping in touch with you is important to us. We may need to contact you about this year’s Memorial Walk and we would like to notify you about the Memorial Walk in the future. In order for us to communicate with you by phone or email, we need your consent to do so. We would be grateful if you could indicate your preferred method of communication below:

Keeping in touch

I am happy for you to phone me
I am happy for you to email me

Please note that you can withdraw these consents at any time by contacting ChampDemoEmail@Champcloud.com. Please also take note that we will retain your details on our Donor Database and we will only contact you with regards to this event in future correspondence.

5. Declaration

DECLARATION: I understand that I enter the Memorial Walk at my own risk and that This CHAMP Demo will not be held responsible for any property lost, mislaid or stolen on the route or at any facility area or for any loss or injury sustained by me in the course of the event or in fundraising connected with the event. Furthermore, I hereby grant full permission to This CHAMP Demo to use photographs, films or recordings of the event for any legitimate purpose connected with the event and/or with the services of This CHAMP Demo.

Agree to Terms*

I agree to Terms above.

Name

This field is for validation purposes and should be left unchanged.

Walk Registration Form – w/idonate

Memorial walk registration

1. Personal Details

2. T-Shirts

3. Sponsorship Cards

4. Keeping in Touch

5. Declaration

Basket

Walk Registration Form – w/idonate

Memorial walk registration

1. Personal Details

2. T-Shirts

3. Sponsorship Cards

4. Keeping in Touch

5. Declaration