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Wales Sponsorship Pack Request Form

Fields marked with an * are required.

Please select the event you'd like to register for -

Please note for the Cardiff 10k run you must pay a registration fee, details on how to do this are on the event page at www.diabetes.org.uk/cardiff10k

* Title -

* First Name -

* Surname -

* Address 1 -

* City -

* Postcode -

County -

* Telephone -

E-mail address -

Date of Birth (DD-MM-YYYY) -

Gender - Male
Female

Do you have a particular reason for supporting Diabetes UK?

Fundraising target (How much do you aim to raise?) -

Please tick this box if you would like to hear about future Diabetes UK Cymru fundraising events and give your preference(s) below -

If you have opted to hear about future events, please let us know your preference(s)Cycling
Running
Walks
Social

How did you hear about the event?

Please give any further details you feel would be helpful (such as name of newspaper, where poster was seen)

For certain events we supply a complementary T-shirt or running vest. Please let us know which you would prefer -

Please let us know what size you would like:

I am happy for Diabetes UK to contact me by e-mail (If e-mail address given)

Diabetes UK takes data protection very seriously. We promise we will not pass your details on to any other organisations. If you DO NOT WISH to receive further information about the work of Diabetes UK and that of our trading company please tick this box

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Wales Sponsorship Pack Request Form

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