My Details

My Address

Emergency Contact Details

Please provide a name and telephone for your emergency contact who will not be taking part in the event with you.

Donations

If you are unable to ask for sponsorship, please consider a donation if you can to help support the hospice Choose an amount:



* I am a UK taxpayer and understand that if I pay less Income Tax and/or Capital Gains Tax in the current tax year than the amount of Gift Aid claimed on all my donations it is my responsibility to pay any difference.

Medical Conditions

I have read and understand the Terms & Conditions *

About the event


Let's keep in touch

Your support helps us care for people living with a life-limiting illness in North Hampshire and we look forward to keeping in touch with you by post and phone, sharing our news, activities and appeals. Please tick below if you would like to receive our emails too?