Extreme run sign-up form

Title* << select >> Mr Miss Ms Mrs Dr Professor Other  

(Title other)

First name*  

Last name*  

Email*    

Date of birth* (dd/mm/yyyy)    

Address 1*  

Address 2

Town/City*  

County

Postcode*  

Which extreme run are you taking part in?*  

Extreme run date* (dd/mm/yyyy)    

Extreme run distance*  

Stand out from the crowd in our famous green running top. Please indicate whether you would like one of our exclusive T-shirts or vests:

Dri-flo T-shirt (size) << select >> Small Medium Large Extra large Double extra large Not required

Or

Dri-flo vest (size) << select >> Small Medium Large Extra large Double extra large Not required

We offer iron-on letters to all runners to go on the front of your T-shirt or vest. If you would like your name or nickname, up to a maximum of 6 letters, please indicate below:

Your letters

Please select << select >> Macmillan website Race organiser's website Runners World website Run Britain website Google Other search engine Race organiser's magazine Mail / email from Macmillan Local press From Boots Other (please specify)

(other)

Macmillan Cancer Support and our trading companies would like to hold your details in order to contact you about our fundraising, campaigning and services for people affected by cancer.

If you do not want us to contact you about other ways to support us, please tick here.

We do not sell or swap your details with any third parties, but in order to carry out our work we may need to pass your details to service companies authorised to act on our behalf. Find out more about how we use your details.

Please tick to confirm you have read and agree to the statement below:  

By submitting this form, I acknowledge that Macmillan Cancer Support does not accept any responsibility for any injury, loss or damage to me or my property incurred during participation in the above event unless Macmillan Cancer Support, its employees or agents cause the injury or damage by their negligence. Any participant who has any concern about his or her physical condition is advised to consult their doctor before taking part in the event.