Fundraising Registration Form

Thank you very much for supporting the hospital charity. The Charity exists to support patients by providing extra equipment and facilities, and by funding medical research. Please take a few minutes to complete this form and return it to the address below. This will help us to identify ways in which we can help to make your fundraising a great success.

Personal Details

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Materials

We will send you a fundraising pack containing items which might be helpful for your fundraising. This could include collection tins, sponsorship forms, newsletters, donation envelopes, stickers etc. If you require charity t-shirts please indicate how many and which size. For those participating in a physical challenge we have sports vests available.

e.g. Can we talk you through setting up an online sponsorship page or clarify if public collections are permitted, etc?

Your Event or Planned Fundraising


Declaration

I understand that I should seek medical advice from my general practitioner if I am in any doubt about my physical ability to take part in this event.

I acknowledge that I am undertaking this activity entirely at my own risk and that the hospital charity shall not be liable in any way for any injury or loss that might occur as a result of my participation.

I understand that the hospital charity will, in no way, be liable for any claim which may arise from this event.

I agree to pay all proceeds of the event to the hospital charity within 8 weeks of the event taking place.

£

If you're under 18 please provide contact information for your parent/guardian


Data Protection Statement

The hospital charity will keep a record of your details on file regarding your fundraising. In addition, we would like to be able to contact you with our quarterly newsletter as well as with other information on events or areas of our work we think may be of interest to you.

© 2017 Queen Elizabeth Hospital Birmingham Charity is a working name of University Hospitals Birmingham Charity, a company limited by guarantee in England (No.10004003) and a charity registered in England and Wales (No.1165716).

Registered Office: 5th Floor Nuffield House, Queen Elizabeth Hospital, Birmingham B15 2TH

Website: clevercherry