Challenge event registration form

First name

Surname

Mobile

Date of birth

Address line 1

Address line 2

City/town

Postal code

Country

Event

Date of event

Are there any other events that you're interested in?

Vest/cycling jersey size

What's your connection to cardiomyopathy?

Other

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

If you're applying for a Cardiomyopathy UK charity place in an event, are you happy to accept our fundraising target?

Yes

I have my own place

How much are you hoping to raise and how will you fundraise?

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

Yes

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

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.

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.

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