Application for the Bupa London 10km 2015

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Application for the

Bupa London 10km 2015




Telephone number:

Email address:

Date of birth:

Running vest size:

S - 38'


M - 40'


L - 43'


XL - 45'


Will this be your first 10km event?

Name of employer:

Does your employer offer matched funding? If yes, what is the max.?

(check with your HR department to see if your employer offers this benefit – where they will match £ for £ the amount you raise)

Are you currently employed by a corporate supporter of St Joseph’s Hospice?

Fundraising target:

(Before match-funding; the minimum target is £200. Please note, this does not include gift aid)

How do you plan on raising this amount?

Who or what is your motivation to support St Joseph’s Hospice?

How did you hear about St Joseph’s involvement in this event?

Please let us know if you’d be happy for our PR Team to contact you regarding your story, if suitable

(If yes, please be sure to include as much information about yourself and your challenge including your motivations on your form!

Please note, choosing yes does not guarantee that our PR team will be in contact)






Tell us a little bit about yourself!:

(e.g. fitness goals/journey)

How we contact you:

☐ We would like to send you updates about our work by email, if you are happy to hear from us this way, then please tick this box

☐ We would also like to send you updates and information by phone and by post, if you prefer not to hear from us this way then please tick this box

Please note that will not share your details with any other organisations unless they are working on our behalf. Thank you for your support!

Please return completed form to or post to:

St Joseph’s Hospice, Events Team, Mare Street, Hackney, London E8 4SA

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