Register your interest

Thanks for your interest! This application form is for our supporters who want a National Eczema Society place in the Great North Run 2025.

First Name *

Last Name *

Date Of Birth *

Email *

Phone Number *

Address Line One *

Address Line Two

Town/City *

County

Postcode *

Country *

Please confirm you are applying for a National Eczema Society place in the Great North Run 2025? *

Yes No

Why do you want to support National Eczema Society by running in this event? *

Please tell us a little about your connection with eczema.

Have you taken part in a running event before? *

Yes No

If yes, what was the event(s)? And what was your time?

Are you confident of achieving our minimum fundraising target of �300? *

Yes No

Please tell us how you plan to raise the money to reach your fundraising target. *

Any other comments?

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