Challenge event registration form

Your Name
Address
What's your connection to cardiomyopathy?
Who is affected by cardiomyopathy?

Cardiomyopathy UK is entirely dependent on funds raised by our supporters as we receive no government or NHS funding. We are very grateful to all of our fundraisers, many of whom are personally affected by cardiomyopathy and myocarditis.

The charity has a duty of care for the health and welfare of all of our fundraisers. In this respect, when anyone who is diagnosed with a serious health condition such as cardiomyopathy or myocarditis, or if anyone in your immediate family has cardiomyopathy, and wishes to undertake a challenge event, we kindly ask that they provide us with a written statement of fitness to participate from their cardiologist, dated within 1 year.   

Do you have a statement of fitness dated within the last year?
If you don't have one, our team will guide you through how to get this.
If you're applying for a Cardiomyopathy UK charity place in an event, are you happy to accept our fundraising target?
Where a registration fee is required, I understand that my place is not confirmed until this has been paid.
Would you be interested in sharing your story to support and inspire others?
This could be in our My Life magazine, on social media or as part of one of our campaigns.
Would you like to receive email updates from us about the latest support and information for people affected by cardiomyopathy, our campaigns, research and ways to get involved?
If you change your mind, you can unsubscribe at any time by contacting us. We will never sell or share your data with any third parties unless required to do so by law.
Would you like to receive our free quarterly My Life magazine by post?
If you already receive My Life by post, please select yes.

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