Skydive

My Details

Prefix

First Name *

Last Name *

Email *

Phone Number *

My Address

Address Line One *

Address Line Two

Town/City *

County

Postcode *

Country *

Company/organisation

Date Of Birth *

Date of Jump *

Which height jump will you be doing? *

Will you pay for the jump yourself or will you raise the minimum level of fundraising? *

T-shirt Sizes *

How did you find out about the skydive?

Are you taking part in memory of someone? If so, please let us know their name

Are you willing to share your story?

Yes No

Your support is vital to Dorothy House and we'd love to share our news, campaigns and events with you, as well as ways you could get involved and provide support. Please choose your preferences below:

Post *

Yes No

E-mail *

Yes No

Please tick that you have read and accept the terms and conditions

I have read and understand the Terms & Conditions

Create or Join a Team

CREATE FIND

Donations

After paying your £50 deposit, you may be paying for your skydive yourself or raising sponsorship to cover the remaining costs of your skydive. Either way, if you'd like to donate to Dorothy House now, this is your opportunity to do so.

Choose an amount:

�10

�20

�50

�100

Other (�)

No Donation

Gift Aid Declaration:

* 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.

My Details

My Address

Create or Join a Team

Donations

Create a team

Join a team

Invite your friends

Create a Team

Optional...invite more friends