Complete the form below to receive your Bake a Difference fundraising pack. First Name Last Name Email Mobile Home Address Address Line 2 Address Line 3 Address Line 4 City Post Code fieldset3 What's your connection to cardiomyopathy? fieldset2 - Select -I have cardiomyopathy or a related conditionI am a friend/family member of someone with cardiomyopathyI would like to support the charity in memory of a loved oneCardiomyopathy UK is my employers charityI am a healthcare professionalOther fieldset4 What kind of Bake a Difference are you doing? What kind of Bake a Difference are you doing? - Select -Coffee morningBake saleBake Off competitionOther… Enter other… fieldset5 Where are you holding your Bake a Difference? Where are you holding your Bake a Difference? Where are you holding your Bake a Difference? - Select -HomeSchoolWorkOther… Enter other… fieldset6 When are you holding your Bake a Difference? When are you holding your Bake a Difference? When are you holding your Bake a Difference? - Select -Fri 26th MaySat 27th MayNot sure yetOther… Enter other… What size T-shirt would you like?? - Select -SMLXL How much are you hoping to raise? - Select -Up to £100£100 - £250£250 - £500£500 - £1,000£1,000+ What’s your reason for supporting Cardiomyopathy UK? Is there anything else you'd like to tell us about your Bake a Difference? Would you be interested in sharing your story to support and inspire others? Yes 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? Yes No