ENTRY FORM

    
  PLEASE HELP - FUNDS FOR
HEART FAILURE & CANCER REHABILITATION RESEARCH
Exercise4Life has grown and is now running continuously from 01 SEPTEMBER 2011! You have the chance to repeat your favourite event(s) or take part in all 8! A different challenge will be promoted each month, click on event calendar to plan your participation…Good luck!
 Supporting

  
 

Name of Centre(s) you wish to participate at
Town/City

PLEASE COMPLETE ALL FIELDS, BELOW

Surname (Last Name)
First Name in Full
Email Address
Address 1
Address 2
Town
County/Country
Postcode
Daytime Telephone
Age and DOB if under 16
Your details will not be given to any third party

Which challenges in your area would you like to hear about?
(You can select as many as you like)

Swimming   Running   Cycling   Dance Alive
Walking   Nordic Walking   Dancing   Hula Hooping

Can you help? (Details could be used for publicity). Please give details of any interesting personal items or anecdotes about yourself, or why you are entering Exercise4Life.

If you are having difficulties with this form please call +44 (0) 1382 451146


  • Send money through virginmoneygiving.com
  • Or send a cheque or postal order made payable to WRIGHT Foundation Research, along with your sponsorship form to PO BOX 159, Dundee, DD1 9HF, UK.
e.info@exercise4life.org w.www.exercise4life.org t. +44 (0) 1382 451146 f. +44 (0) 1382 451163 a. EXERCISE4LIFE PO BOX 159 Dundee DD1 9HF
  

 
 
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