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:
	Great Manchester Run 17/05/09
	BUPA London 10,000 25/05/09
	Albert Bartlett Edinburgh Marathon 31/05/09
	British 10K London Run 12/07/09
	Mazda London Triathlon 01/08/09-02/08/09
	Adidas Women's 5K Challenge 06/09/09
	Great North Run 04/10/09
	Great South Run 25/10/09
	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?


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!