CSY Registration form for the Firewalk - 17th October 2021

Personal Information

Country*
Email*
Confirm Email*
Phone*
Emergency Contact Name
Emergency Contact Number
How did you hear about this?
Reasons for Participating
Do you have a personal target to raise?

Consent Information

CSY would like to keep you informed about our projects and fundraising activities and ask you to opt-in to our communication options. We don't share information with any third parties and you can unsubscribe at any time by contacting us.
 
May we continue to contact you with information about our organization and volunteer opportunities?

For publicity purposes we would llike to share photos from event day. Can we use your photos?

Registration fee

Quantity
Price
Total
Registration fee

Registration covers the entry fee. Please complete 1 registration form per participant. Fees are non refundable.

X
£
15.00=
£
0

Declaration

Declaration – I, the undersigned, commit to raising £100 in sponsorhsip via JustGiving in aid of Cancer Support Yorkshire.  

 

Personal sponsorship forms will be issued at your request.

Please Note - money and forms, used and unused, must be returned by Monday 1st November 2021.

 

By submitting this form you are confirming that you are happy to proceed with a Firewalk challenge. If you have any questions please see the FAQs page of UKFirewalk here 

 

Payment Information

Amount*
£
Payment Type
We only accept credit/debit card payments. After you complete this form, select Submit to enter your card details into our secure transaction processor. Your submission will be processed when you finalize your secure payment information.
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