THc Running Application

Personal Details
	Title
	First Name *
	Surname *
	Company Name
	Address & Contact Details
	Line 1
	Line 2
	Town
	County
	Postcode
	Country
	Daytime Tel No *
	Mobile Tel:
	Email
Emergency Contact on Day
	Name of Contact *
	Tel No. of Contact *
Choice of Run
	Please indicate your chosen running event: *	British 10k Ladies 8k Windsor Half other
	If you ticked "other" because you have a confirmed place in alternative running event (eg: London Marathon) please give details:

	How did you hear about the THc Running Programme?
	Do you suffer from any health problems that might require medical attention during the run? *	Yes No
	If yes, please state including any prescribed medication:
	I understand if I am in any doubt about my health, or have a medical condition that may be affected by exercise, I should obtain my doctor's approval before participation. *

Free Running Vest
	Please indicate the size you require:	Small Medium Large Extra Large
Fundraising Pledge
	I understand this is a fundraising event and pledge to raise as much sponsorhip as possible and in the event that I am unable to raise sponsorship and have used a Thames Hospicecare space, I agree to pay the entry fee that THc have incurred. *