Challenge event registration form

First Name

Last Name

Mobile

Date of Birth

Home Address

What's your connection to cardiomyopathy?

We love to get to know our fundraisers so please tell us about yourself and your reasons for supporting Cardiomyopathy UK

Event

Date of event

Are you applying for a charity place or have you secured your own place?

I want a charity place

To secure a charity place you will need to raise the minimum fundraising target

I have my own place

There's no minimum fundraising target, raise as much as you can

How will you raise the minimum fundraising target?

How much are you hoping to raise and is there anything we can do to help you with your fundraising?

Where a registration fee is required, I understand that my place is not confirmed until this has been paid.

Yes

Running vest/cycling jersey size

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?

Yes

I understand

We would advise anyone with cardiomyopathy, a related condition*, a device fitted or a hereditary risk of cardiomyopathy or related conditions to speak to their doctor before undertaking any challenge that involves significant physical activity to understand any possible risks and agree that it is safe to go ahead.

If you are applying for one of our charity places in an event, please note that Cardiomyopathy UK may be unable to grant you a place if, upon guidance from a cardiologist, we do not feel the intended activity is safe. Read our fundraising safely information

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