Event registration

Thank you for wishing to take on such a fantastic personal challenge in aid of Pilgrims Hospices.

My preferred date to Wing Walk is:*

Have you Wing Walked in aid of us before?

Your details

Title*

Other*

First name*

Surname*

Your Gender*

Your date of birth*

Address*

Address Line 1 Address Line 2 Town/City County Postcode

Contact details

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.

Your participation

Emergency contact name*

Emergency contact number*

Are you taking part in memory of a loved one? (If yes, please provide their full name and relationship to you)

T-Shirt Size (All Wing Walkers will receive a Pilgrims t-shirt on the day of their jump)*

How did you hear about our Wing Walk days?*

Other*

Does your company have a matched giving scheme that you can apply for in order to boost your fundraising?*

Name of company/employer

Disclaimer*

I commit to raising at least £650 for Pilgrims Hospices. I agree to forward at least 50% of my sponsorship (£325) to Pilgrims Hospices no later than 4 weeks before the date of my Wing Walk. I understand that I take part in this event at my own risk and that the organisers will not be liable for any injury or illness except where injury or illness is caused by their negligence and they are legally liable. I agree to abide by any terms and conditions of the event as agreed by the organisers (The Wing Walk Company and Pilgrims Hospices). I agree to follow any and all safety instructions given by the organisers before and during the event. By taking part in the event, I agree to Pilgrims Hospices using my name and any footage or photographs taken during my participation to be used in any future promotional material. (Please tick to indicate that you have read and agree to the disclaimer)

Terms & Conditions*

Please tick to confirm you have read The Wing Walk Company's Terms and Conditions

Total

£ 0.00

Wing Walk Application Form

Care for you