Vhi Women's Mini Marathon 2017

Contact Information

Country*
State / Province*
Address*
City*
*
*
*
*
*
*
Email*
Confirm Email*
Mobile Phone No*
Vhi Registration Number (Entrant Number)

*Please note you must register with the Vhi at www.vhiwomensminimarathon.ie to get your race number and entry for the day.  Entries close Friday 28th April.

How many Sponsorship Cards do you require?
Are you running as part of a team? If so, let us know the name of your team/team leader

Please indicate below which size running vest you require.  This will be sent out in your Mini-Marathon Pack together with a hat & sponsorship card(s).

Vest Size*
  • Size 6-8
  • Size 10-12
  • Size 14-16
  • Size 18 +
How did you hear about the Oesophageal Cancer Fund?*
  • Previous OCF Mini Marathon Participant
  • Lollipop Day 2017
  • Advertisement/Media
  • Facebook
  • OCF Website
  • Previous Lollipop Day Volunteer
  • Family member affected by Oesophageal Cancer
  • Other -please specify below
I consent to further contact from the Oesophageal Cancer Fund*
  • Yes
  • No

Thank you.  Your support will enable us to continue funding our Oesophageal Cancer Awareness Programme.


 

For further information please call 086 4542713 / 086 0697328 or email info@lollipopday.ie

Additional Comments

Security Code

Share This Form

Powered by eTapestry.