Race Calendar

I Run For Wine

About You

First Name:

Last Name:

Date Of Birth:

Gender:

Is Wheelchair Entry:

Contact Details

Contact Telephone:

Email:

Address:

Address Line 1:

Address Line 2:

City:

Postcode:

Entry Details

Entry Type:

Contact in Case of Emergency:

Phone in Case of Emergency:

Additional Information:

Team Member

First Name:

Last Name:

Date Of Birth:

Gender:

Charitable Donations

The Running Bug is fundraising for Dog's Trust. If you would like to make an additional donation to Dog's Trust, please enter an amount next to the chosen charity.

Donation to Dog's Trust:

Please treat my donation(s) as a Gift Aid donation.

I confirm I have paid or will pay an amount of Income Tax and/or Capital Gains Tax for the current tax year (6 April to 5 April) that is at least equal to the amount of tax that all the charities and Community Amateur Sports Clubs (CASCs) that I donate to will reclaim on my gifts for the current tax year. I understand that other taxes such as VAT and Council Tax do not qualify. I understand the charity will reclaim 25p of tax on every £1 that I have given.

About Entrant _1

First Name:

Last Name:

Date Of Birth:

Gender:

Is Wheelchair Entry:

Contact Details

Contact Telephone:

Email:

Address:

Address Line 1:

Address Line 2:

City:

Postcode:

Entry Details

Entry Type:

Contact in Case of Emergency:

Phone in Case of Emergency:

Additional Information:

Team Member

First Name:

Last Name:

Date Of Birth:

Gender: