BERLIN MARATHON 2014 OWN PLACE REGISTRATION FORM If you have secured your own place in the Berlin Marathon and would like to join the Anthony Nolan team, please complete this registration form in as much detail as possible. Please note, if you have secured your own place, there is no minimum sponsorship requirement. We simply ask you to raise as much as possible to support Anthony Nolan’s vital work (due one month post event). All fields are mandatory Title First Name(s) Gender Surname Date of birth Age on race day (You must be 18 or older to take part in this event) Address Town/city County Telephone Post code Mobile** Email address* Occupation Company Name Does your company have a matched giving scheme? If yes, how much are they likely to match? How did you hear about the Anthony Nolan team? (please tick) Advert on Real Buzz website Anthony Nolan website Google or other search engine Already support Anthony Nolan (please specify) Workplace Other (please specify) Why do you want to run for Anthony Nolan? Facebook Twitter Would you be happy to share your story with other runners or the media? Yes No Have you taken part in any other running events? If so, which ones? Did you fundraise for a charity in these events? If so, which charity and how much did you raise? We would like to offer you a complimentary high quality running vest, to train in and to wear with pride on race day. Please let us know which size you would need. Male XS S M L XL XXL Male: XS=36’’ S=38’’ M=40’’ L=42’’ XL=44’’ XXL=46’’ Female XS S M L XL XXL Female: XS=32’’ S=34’’ M=36’’ L=38’’ XL=40’’ XXL=42’’ We will also send you iron on letters to put your name on the vest. Please specify what name/nickname you would like. FUNDRAISING How much do you pledge to raise for Anthony Nolan? Please outline below how you plan to raise your sponsorship money. TERMS AND CONDITIONS, AND DECLARATION Before submitting your application, please read through our full Terms and Conditions and sign the following declaration. By signing, you agree to the Terms and Conditions below. I confirm that I am applying to join the Anthony Nolan Berlin Marathon team. I commit to raising as much as possible for Anthony Nolan. Name: Date: Data Protection Anthony Nolan values your support and promises to respect your privacy. The data we gather and hold is managed in accordance with the Data Protection Act (1998) by us and our subsidiary company Anthony Nolan Trading Ltd. We would like to keep you informed about our vital work and how you can help. If you do not want to receive this information please let us know by ticking this box *E-mail is an environmentally friendly, cost effective way to keep you involved in our activities. If you would be happy to receive general email communications from us about our vital work and fundraising then please let us know by ticking this box **Similarly we would like to keep you up to date with our work by text message/SMS. If you would be happy to receive communications from us about all our lifesaving work in this way then please let us know by ticking this box THANK YOU FOR YOUR INTEREST IN JOINING THE ANTHONY NOLAN BERLIN MARATHON TEAM. Please email your completed application form to [email protected] If you have any questions about the application process, please call 0303 303 3000. TERMS AND CONDITIONS FOR OWN PLACE RUNNERS IN THE 2014 BERLIN MARATHON Berlin Marathon, 28 September 2014 (the ‘Event’) By choosing to run with my own place for Anthony Nolan I agree with Anthony Nolan that: Registration and participation 1. I will inform Anthony Nolan Events Team immediately if I am unable to take part in the Event. All monies paid to Anthony Nolan to this point may be non-refundable and treated as a donation. Minimum fundraising target 2. I pledge to raise as much as possible for Anthony Nolan through my participation in the Event. Donations and payment terms 3. I will keep details of the names and addresses of, and amounts donated or pledged by, all donors and provide such details to Anthony Nolan on request. 4. I will regularly pay all money collected on behalf of Anthony Nolan to Anthony Nolan directly to the Anthony Nolan team by; •Paying online with your credit or debit card, using a fundraising website such as www.justgiving.com or www.virginmoneygiving.com •Calling the events team on 0303 303 3000 with your credit or debit card details •Sending cheques made payable to ‘Anthony Nolan’ to: The Events Team, Anthony Nolan, 2-3 Heathgate Place, 75-87 Agincourt Road, London NW3 2NU 5. I will send an accompanying breakdown of how the money was raised and return all used and un-used sponsor forms. Fundraising 6. I will comply with any fundraising guidance or advice issued by Anthony Nolan. 7. I will pay any money I collect in Anthony Nolan’s name to Anthony Nolan. 8. I will use only lawful means to fundraise for Anthony Nolan and will not do anything that harms or is likely to harm Anthony Nolan ‘s reputation. 9. I will not use the Anthony Nolan logo without permission and will obtain all fundraising materials from Anthony Nolan. 10. My fundraising will not include: a.Raising funds by carrying out door-to-door or unsolicited collections; b.Collecting in any public place without first obtaining authorisation from the local authority and any other licences or consent that Anthony Nolan require me to obtain c. Collecting on private property (including shops, pubs etc) without first obtaining permission of the owner of the private property. d. Conducting any raffle or lottery or putting on any public Event without first contacting Anthony Nolan and taking any steps which Anthony Nolan require. 11. I agree that Gift Aid payments cannot count towards the fundraising total and instead will be considered as over and above the pledged fundraising total. Personal data and images 12. I give permission for the free use of my name, picture, image, feedback and comments in any future publicity, advertising, fundraising materials and/or promotion. 13. I give permission for my personal information to be stored and used by Anthony Nolan in connection with the organisation, promotion and administration of the Event. Health, safety and fitness 14. I take part in the Event at my own risk and will not hold Anthony Nolan or any connected persons responsible for any accident, injury or illness sustained to the fullest extent possible in law. 15. I will fully prepare myself for the physical challenge of the Event and I will check with my doctor to ensure that I am medically fit to participate in the Event. 16. I will comply with any health and safety and other rules or guidelines issued by Anthony Nolan or any Event organisers. Dates, changes and termination 17. This agreement will be valid from the date on which I sign until 30 December 2014, unless terminated earlier by Anthony Nolan. 18. Anthony Nolan may vary or terminate this agreement by giving written notice to me. 19. I confirm that I will be at least 18 years old on 28 September 2014 and I accept all the points stated in these terms and conditions. Anthony Nolan is a company limited by guarantee with charitable status. Charity Registration number: 803716/SC038827. Registered office: Royal Free Hospital, Pond Street, Hampstead, London, NW3 2QG.
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