Walk with your Heart registration form 2023 (Civi)

First Name

Last Name

Mobile

Date of Birth

Home Address

The number of people in your group

Tell us the names of the people in your group

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

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