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Bournemouth Supernova 5k Agreement Form
Bournemouth Supernova 5k Fundraiser Agreement
LHM Guaranteed Charity Place Entry Fundraiser Agreement
To be eligible for a charity place for the Bournemouth Supernova 5k taking place on Saturday 5th October 2019, please complete the form below.
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*
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*
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*
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*
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Why would you like to support LHM?
*
Have you supported LHM in the past?
*
Have you taken part in any running events in the past?
*
How much do you hope to raise? (Please note, there is a minimum sponsorship of £50 for this event.)
*
Will your employer match your fundraising?
*
Yes
No
Don't know
If yes, what is the name of the company you work for?
Any questions or comments?
Agreements
Registration Fee
*
• I agree to pay a non-refundable registration fee of £30 (plus transaction fee of £2.50) • I understand that my place is not guaranteed until this fee has cleared • I will inform Little Hearts Matter immediately if I am unable to take part in the event. All monies paid to Little Hearts Matter to this point may be non-refundable and treated as a donation.
Agree
Donations & Payment Terms
*
• I pledge to raise a minimum of £50.00 for Little Hearts Matter through my participation in the Event • I understand that all sponsorship monies must be paid to Little Hearts Matter within 30 days of the Event taking place • I will use a sponsorship form to collect details of my offline sponsors and any possible Gift Aid declarations and send these to Little Hearts Matter following the Event. • I will, if the sum of £50 has not been paid in by one month after the event, pay the remainder from my own personal funds within one month of this date or in instalments to be agreed with Little Hearts Matter in writing • I understand that Gift Aid cannot count towards the £50 minimum sponsorship total
Agree
Fundraising
*
• I will only collect money for Little Hearts Matter in connection with the Event • I will only use lawful means to fundraise for Little Hearts Matter and will not do anything that is likely to harm Little Hearts Matter’s reputation • My fundraising will not include door to door collections, street collections (without first obtaining written permission from the local authority), collections on private property (without first obtaining written permission from the property owner), or conducting a raffle or lottery at a public event • I agree that Little Hearts Matter can terminate my authority to fundraise on their behalf at any time by sending written notice to the address given by me overleaf.
Agree
Personal data
*
• I give permission for the free use of my name, picture, image, feedback and comments in any future publicity, advertising or fundraising materials, including on the internet and social media sites • I give permission for my personal data to be stored and used by Little Hearts Matter in connection with the organisation, promotion and administration of the event (you can opt out of being contacted overleaf)
Agree
Health and safety
*
• I take part in the event at my own risk and will not hold Little Hearts Matter responsible for any accident, injury or illness sustained to the fullest example possible in law • I will fully prepare myself for the physical challenge of the event and I will check with my doctor to ensure that I am medically fit to participate in the event • I will comply with any health and safety guidelines and any other rules issued by the event organisers
Agree
Payment
Registration fee payment
*
Price:
£ 32.50
Total
£ 0.00
Declaration and signature
By signing (initialing) this form, I confirm that I will be 18 years old on 5th October 2018 and I accept all of the points stated in the fundraiser agreements. I will pay my non-refundable registration fee of £32.50 and understand that my place cannot be confirmed until payment has been received and cleared.
Signed (Initials):
*
Name:
*
Date:
*
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