Epilepsy Research UK - support us - do an event for Epilepsy Research UK

Support us - Do an event for Epilepsy Research UK

Please complete this form if you would like to run or do an event on our behalf:

Your details
Name
Mr/Dr/Ms/etc
Address
Phone (day)
Email

Race details
I want to take part in:
	adidas Silverstone Half Marathon
	Virgin London Marathon
	Bupa Great Manchester Run
	Edinburgh Marathon Festival
	Bupa London 10,000
	British 10K London Run
	Virgin London Triathlon
	Big Fun Run Series - please indicate race of interest in 'commitment' box
	adidas Women's 5K Challenge
	Bupa Great North Run
	Bupa Great South Run
	London to Brighton Cycle Ride
	Other. Please specify:


I want to do a skydive for Epilepsy Research UK

My vest/T-shirt size is:
	S	M	L	XL
	XXL

A minimum sponsorship target applies to guaranteed charity entry. The amount varies with the event. There is no minimum sponsorship target for independent entry.


Your commitment
Why do you want to fundraise for Epilepsy Research UK?

Would you like to raise money in memory of a particular person? Please give their full name:


Occupation

How did you hear about us?
	London Marathon website
	Great Run website
	Google or other search engine
	Other. Please specify:


Please tick if you do not wish to receive our
	e-newsletter (monthly)
	Focus newsletter (3 issues per year)

Thank you for your interest in supporting epilepsy research!