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On Your Marks for Little Hearts

‘On Your Marks for Little Hearts’

Application Form

Thank you for entering ‘On Your Marks for Little Hearts’

Before you complete the form, please read through the following information.
  • Entry costs: £15.00 per adult,
                          £10.00 for ages 11 to 16 years
                        Entry cost includes a t-shirt.The Fun Run is free.
    These entry fees will cover the charity’s costs in organising and running the event. It also means that any sponsor money which you raise will go directly towards supporting the work of Little Hearts Matter.
  • Please can cheques be made payable to ‘Little Hearts Matter’
  • Fields marked with a * are mandatory
 
Race Attending:
(e.g. Shugborough, Worthing)
 
     
Personal Details    
* Title:  
* First Name:  
* Last Name:  
Age
* Date of Birth:  
If under 18 years of age
(please complete)
Parent / Guardian Name Address (if different from below)
Parent Name
*Parent Address 1:  
Parent Address 2:
Parent Address 3:
Full Postcode:
Company Details
Company Name
Contact Details
* Address 1:  
Address 2:
Address 3:
* Full Postcode:  
* Email:  
* Telephone (Home):  
* Telephone (Work):  
* Telephone (Mobile):  
Distance Entered


 
Please tick the boxes relevant to you
If yes, please give details
Please choose your t-shirt size: medium, large
Race Rules  
Personal Information
Thank you for your support, Little Hearts Matter (LHM) will use your personal information for administration purposes and to provide you with services or information that you have requested. We greatly value your support and would like to keep you informed through marketing literature by post and email about our work or our events.

If you do not wish to fill in the form please print and return along with payment to: -

Little Hearts Matter, 11 Greenfield Crescent, Edgbaston, Birmingham, B15 3AU
Telephone: 0121 455 8982, Email: info@lhm.org.uk
Website: www.lhm.org.uk