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Midnight Walk 2013 registration form

Weldmar's seventh ladies only walk along Weymouth's seafront - with three routes to choose from.

Personal information

Title

Forename *

Surname *

Address *

Date of birth *

Phone number

Mobile phone

Email address *

Please advise us of any medical conditions you may have

If you have any special dietary requirements, please let us know

T shirt size *

Which route will you be walking?

Route options *

10 miles
6.5 miles
5 miles

Entry fee

Please choose the correct entry fee *

Are you walking as part of a team?

We love it if you want to walk as a team. If you are, please let us know your team name so that we can organise properly labelled sponsorship forms

Team name

Why are you walking the Midnight Walk?

Please let us know

Terms and conditions

I have read and accepted the Midnight Walk terms and conditions (tick to agree) *

Data Protection

The information you have provided will be used to fulfil your request. It will not be passed to a third party.

We would like to be able to send you updates and information about our fundraising events including the Midnight Walk.

If you would prefer not to receive this, please tick here.

We would also like to be able to send you our newsletter and update you on the work of Weldmar Hospicecare.

If you would prefer not to receive this, please tick here.