#Brizzz Sleep Out 2017 registration form

 

 

Register here to take part in the #Brizzz Sleep Out 2017 in support of 1625 Independent People.

 

We'll be making our beds out in the cold to show solidarity with the 83,000 young people in the UK faced with homelessness every year. This is our largest fundraising event of the year, harnessing support from local businesses and individuals to help young people in the local area to reboot their lives. 

 

By registering below you are agreeing to Sleep Out with us on the night of Wednesday 15 November at the Trinity Centre, Old Market, Bristol. Each sleeper pledges to raise a minimum of £92 sponsorship; this is what it costs us on average to support one young person for a fortnight.

Purchase ticket

Quantity
Price
Total
Public ticket
X
£
10.00=
£
0

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Mobile Phone*
If you have a medical condition you would like to make us aware of, please give details:
If you do have any access requirements, please give details:
Next of kin/emergency contact name*
Next of kin/emergency contact mobile number*
If you are fundraising as part of a team, please tell us the name of your team:
How did you hear about this event?*
  • Word of mouth
  • 1625ip email
  • 1625ip website
  • Other website (please specify below)
  • Radio (please specify below)
  • Newspaper/magazine (please specify below)
  • 1625ip staff or volunteer
  • Your employer (please specify which company below)
  • Other (please specify below)
  • Past participant
  • Poster
Please give details of how you heard about this event:

We would love to stay in touch and keep you up-to-date with what’s going on at 1625 Independent People. We will never pass your information onto third parties and promise to only contact you about the areas of our work that you have told us you want to hear about.

Are you happy for us to contact you in the future about the following? (Please tick all that apply):*
  • The Brizzz Sleep Out event
  • 1625ip work and services
  • 1625ip volunteering opportunities
  • 1625ip fundraising and event news
  • Acknowledging support and donations
  • Other (please specify what you would like to hear about)
  • None - please do not contact me
Please give details of what you would like us to contact you about:
Are you happy for us to contact you by?:*
  • Post
  • Email
  • Phone
  • Text message
  • Please don't contact me

Payment Information

Amount*
£
Name on Card*
Card Number*
Additional Comments

Security Code