Great North Run Form

Your Name *

Your Email *

Daytime Number

Date of Birth *

Age on Day of Race *

Address *

Address Line 1 Address Line 2 Town or City County Post Code

Company Name

Occupation *

How did you hear about Back Up team places? *

Please detail any running events you have completed

If you have taken part in other fundraising activities for Back Up or any other charity please provide details of the most recent in the box below, including dates and amounts raised:

Would your company consider doing matched funding for this event? *

We would like to use images and videos of you, as well quotes and personal information you supply to us, in Back Up’s fundraising and marketing materials. These materials include, but are not limited to: leaflets, blogs, web pages, social media posts, press releases and other materials – all of which aim to inspire future fundraisers to get involved. If you wish to withdraw consent at any time, please contact our Data Protection Officer at dataprotectionofficer@backuptrust.org.uk.

Are you happy for us to use images of you (moving and still) as well as your name, age, injury level (if appropriate) and quotes in our materials? *

Yes
No

Running Vest/T-Shirt:

Female - vest
Female - t-shirt
Male - vest
Male - t-shirt

Running Vest/T-Shirt Size

Small
Medium
Large
Extra Large

We would like to contact you with information about our services and how you can support us, including ways to volunteer, take part in research, how you can donate to us and how you can get involved in our activities, including fundraising, and events. We promise to always keep your details safe and we will never share your details with any third party.

Yes, please contact me by:

Email
Phone
Text
Post

Your declaration

I understand that if I am accepted for a Back Up Team guaranteed place, I am required to commit to raising a minimum of £400 in sponsorship (excluding Gift Aid)
I agree to the Back Up Challenge Event Terms and Conditions.

Great North run Registration Fee *

Price:

Total

£ 0.00

Great North Run

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