The Bristol Peaks Registration Form

Please complete a separate form per participant

Title*

First Name*

Last Name*

Email*

Phone*

Address*

Street Address Address Line 2 City Post Code

Additional Information

Company (if applicable)

Job Title (if applicable)

Why have you chosen to fundraise for Grief Encounter?

Which size Grief Encounter top would you like?*

Small
Medium
Large
XLarge

Would you prefer a T-shirt or a Vest?*

T-shirt
Vest

Do you have a fundraising target?*

Yes
No

If yes, how much is your target?*

Do you have an online fundraising page?*

Yes
No

If yes what is the url of your fundraising page?

Please tick the relevant boxes below:

I am happy to appear and be named in publicity
I am happy to appear & be named on social media
I am happy to appear & be named on the website
I am happy to appear and be named in print

I agree to the Terms and Conditions for Fundraising In Aid of Grief Encounter. I declare the information provided above is true. I have read the full Terms and Conditions for Fundraising in Aid of Grief Encounter (link below) and understand and agree to them.

Email
Post
Phone

We can only continue to help bereaved children, young people and their families through the passion and generosity of our valued supporters. We'd love to stay in touch and keep you updated with information on our projects and services, including events and fundraising activities. Please tick the box/boxes above that suit you. Rest assured we will never share your data with third parties.

The Bristol Peaks Registration Free

Price:

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