Tough Mudder Application Form

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Tough Mudder Application Form

Donation Amount:

£ 25.00

Thank you for your interest in taking on Tough Mudder as part of #TeamRetinaUK! To apply for one of our places please complete this form. A £25 registration fee is also required when you apply. Registration fees are only refundable if we are unable to offer you a place. Please note - filling in our application form does not guarantee you a charity place. Places aren't guaranteed until you've been offered a place by a member of the team. Once you have been confirmed as a runner for “TEAM Retina UK” we will send you a fundraising pack. If you have any questions please contact Emily Webb on 01280 815900 or email emily.webb@RetinaUK.org.uk

Title *

First Name *

Last Name *

Company

Address *

Postcode *

Date of birth *

Home Telephone *

Mobile Telephone *

Email Address *

T-shirt size

Have you taken part in a Retina UK event before? *

If yes, when?

Why have you decided to take part in Tough Mudder for Retina UK? *

How did you hear about Team Retina UK Guaranteed places? *

What are your key fundraising ideas for raising your £300 sponsorship target? *

Personal Info

First Name *

Last Name

Email Address *

Billing Details

Country *

Address 1 *

Address 2

City *

County *

Zip / Postal Code *

Terms

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Agree to Terms?

Donation Total: £25.00

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