The Virtual Virgin Money London Marathon

Please register for your place in the Virtual Virgin Money London Marathon by completing the form below.

If you have any questions or would like any help or support with your registration, please contact Simon (Community and Events Fundraising Manager) on 07736 925 174 or email simon.taylor@RetinaUK.org.uk.

Please note, as of the 19 February, we have just one remaining charity place in the Virtual Virgin Money London Marathon.

Donation Amount:

£ 14.00

Personal Info

First Name *

Last Name

Email Address *

Postal Address (including postcode) *

Phone Number *

We would like to use your contact details to keep you informed about events, research, fundraising and our regular newsletters and updates. Are you happy for us to contact you via email? Yes No

We’d like to contact you by post and telephone from time to time, but if you would prefer that we didn’t, please tick below: Please don't send me information in the post Please don't call me with information

If you would like to change the way you hear from us, how we use your information or do not want to receive these updates – just email info@RetinaUK.org.uk, call 01280 821334 or write to us at Retina UK, Wharf House, Stratford Road, Buckingham, MK18 1TD. Your privacy is our priority. We promise to keep your details safe and will never sell them. Need extra reassurance? Our privacy policy explains all: www.retinauk.org.uk/privacy-policy.

Date of Birth *

Event information

Running vest size

Do you have a guide runner? Yes No

How did you hear about the event?

By accepting a charity place from Retina UK I agree that:

Charity place

In addition to registration with Retina UK, I understand that I am required to confirm my registration with the event organiser (London Marathon Events Limited), including agreeing to the event organiser’s terms and conditions, in line with information provided by Retina UK and that failure to do this may result in my place being lost.
I acknowledge that I have provided data about myself in order to register with Retina UK for this event and that Retina UK will need to pass this information to the event organiser to register my place.
Registration for this event includes the payment of a non-refundable registration fee of £14.
Any charity place allocated to me is non-transferable and any attempt to transfer my place to another person may result in the place being withdrawn.

The event

All runners take part at their own risk.
I understand that I am taking part in an event that is not organised by Retina UK and that Retina UK accepts no liability with respect to my participation.
I will be aged 18 or over on the date of the event.
If I am unable to take part in the event, I will inform Retina UK immediately.
I give permission to Retina UK to use any photographs/videos taken of me to raise awareness and/or money for its work and/or events.
I understand that Retina UK will contact me via telephone, letter or email for any matter relating to my fundraising and my participation in the event.

Fundraising

I understand that event places have an associated cost to Retina UK and commit to raising a minimum of £150 (excluding Gift Aid and any registration fee paid) for Retina UK.
I commit to raising £120 (80% of the minimum fundraising target) by 12 September 2021 (three weeks before the event) and the remaining amount no later than 14 November 2021 (six weeks after the event date).

Medical history and fitness confirmation

I confirm that to the best of my knowledge my general state of health and fitness is good and I take full responsibility for myself.

Terms and Conditions * I agree to the terms and conditions

Registration Fee:

Billing Details

Country *

Address 1 *

Address 2

City *

County *

Zip / Postal Code *

Donation Total: £14.00

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