London 10,000 application form 2023 Welcome to the Vitality London 10,000 Pilgrims Hospices application form. Thank you for your interest in running in aid of Pilgrims Hospices. Things to know before filling out this form: - We have a limited number of guaranteed charity places in the Vitality London 10,000. These are offered on a first come, first served basis via this online form only. - Secure your place with a £10 (inc VAT) registration fee, which includes a Pilgrims T-shirt. We ask all Pilgrims runners to pledge to raise £100 for their London 10,000 challenge (excluding Gift Aid). All applicants must be at least 18 years old as of 24 September 2023. Your details Title*Please selectMrMissMrsMsMxDrOtherOther*First name*Surname*Your Gender*Please selectMaleFemaleNon-binaryTransgenderPrefer not to sayYour date of birth* DD slash MM slash YYYY Address* Street Address Address Line 2 City County Postcode Contact details Contact mobile number*Email address* Enter Email Confirm Email Must be checked regularly (this is the most effective way for us to communicate with you)By submitting this form, you consent to be contacted by email for the purpose of this event. If you'd like to receive emails about other exciting ways to support Pilgrims Hospices or with news about our work, please tick the box below. I am happy to receive emails where possible You can update your contact preferences at any time by calling our Supporter Relations Team on 01227 782062 or by writing to us at Pilgrims Hospices, Supporter Relations, 56 London Road, Canterbury, Kent, CT2 8JA. We are registered under the Data Protection Act and will never share, sell or swap your details with any third party for the purposes on their own marketing or the monetising of your data. About your participationPilgrims Hospices London 10,000 entry Price: This entry fee forms your commitment to the charity that you intend to fundraise at least £100 and includes an official Pilgrims Hospices technical T-shirt that will be sent to the address provided.Which size of T-shirt do you need? Small Medium Large X Large XX Large No T-shirt required We will send you an Official Pilgrims Hospices T-shirt to wear during your race. These are lightweight, breathable and comfortable for running in.Are you taking part in memory of a loved one? (If yes, please provide their full name and relationship to you)eg. John Smith (father)Where did you hear about our charity places in the London 10,000?*Please selectWebsiteSocial MediaInternet searchEmailWord of mouthFamily memberPilgrims volunteerOtherOther*Do you have a sponsorship target you would like to achieve?£100+£250+£500+Would you be happy for us to use your fundraising story in hospice publicity (e.g. to promote our London 10,000 places)? Yes No Does your employer have a match giving scheme that you can apply to in order to boost your fundraising? Yes No Not sure Name of company/employerBy taking a Pilgrims Hospices charity place in the Vitality London 10,000 2023, I pledge to raise £100 (excluding Gift Aid) for Pilgrims Hospices. I understand that I must show that I am actively fundraising and risk withdrawal if I do not provide evidence of my fundraising at least 4 weeks before the event.* I agree I confirm that I wish to participate in the Vitality London 10,000 2023 through a Pilgrims Hospices charity place. I confirm that all the information provided by me in this form is to the best of my knowledge true and correct. I understand that if any information provided by me in this form is found to be false, I risk withdrawal from the London 10,000.* I agree