Dublin Marathon Sign up form

Dublin Marathon Sign up form
Are you interested in raising money to help get more pancreatic cancer
patients diagnosed in time for surgery?
Then run for Pancreatic Cancer Action in the Dublin Marathon
Pancreatic Cancer Action has 2 guaranteed places in the Dublin Marathon 2012. If you would like one
of these places you need to be able to fundraise a minimum of £375. Pancreatic Cancer Action also
requires a non-refundable deposit of £30 to secure your place.
To register for a Pancreatic Cancer Action place, please fill in the contact details box below. Return the
form along with your deposit to us at PO Box 8, Haslemere, Surrey, GU27 9EY. We will then send you a
fundraising pack, a Pancreatic Cancer Action training t-shirt and lots of encouragement to keep you
motivated.
There are two ways to pay for your non-refundable deposit:
Via cheque made payable to Pancreatic Cancer Action
Online – go to https://pancreaticcanceraction.org/donate/ please annotate with DUBLIN 2012
Please select the appropriate tick box below to indicate the method you have selected to pay with.
Dublin Marathon Registration
First Name
Last Name
Email Address
Mobile Number
Telephone Number
Address
Postcode
I enclose a non-refundable deposit of £30 and commit to raising a minimum sponsorship of £375 for
Pancreatic Cancer Action
OR
I have paid my non-refundable deposit of £30 using the secure online donation system and commit
to raising a minimum sponsorship of £375 for Pancreatic Cancer Action
Pancreatic Cancer Action
PO Box 8 Haslemere
Surrey. GU27 9EY
T: 01428 656269
E: [email protected]
W: pancreaticcanceraction.org
Registered charity No 1137689