Challenge event registration form

Your Name
Address
What's your connection to cardiomyopathy?
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.
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.

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