Personal details Title Mr Mrs Miss Ms Dr First name: Surname: Date of birth: Organisation (if relevant) Address 1: Address 2: Town: County: Postcode Must be correct format eg M20 4BX with space between Daytime phone: Evening phone: Mobile: Email: Confirm email: If you are 14 years old or younger please ask a parent or guardian who will be responsible for your event to complete the following section: Parent name: Parent phone number: Parent email address: Event details Name of fundraising event: Event date: Venue: Event details: (brief description of event and activities) Expected number of attendees Other people involved: Do you have a fundraising target you would like to share with us?: Sponsor form required? No Yes Do you require Christie T-shirts? (1 free t-shirt for event organiser) No Yes T-shirt sizes (S, M, L, XL, XXL) Additional t-shirts can be purchased for £4.00 each. Please let us know if you also wish to receive any of the following items in your fundraising pack: Sashes (provided for helpers to wear) Number of sashes required Collection boxes Charity leaflets Balloons Banner tapes Stickers Raffle books Will you be using Justgiving.com to donate?: No Yes What is the name of your Justgiving page?: www.justgiving.com/ Are you raising money in memory/celebration of a relative, friend or colleague? Do you have a special story that you would like to share with us? Please provide details if appropriate: Would you like to support a particular area of The Christie's work: Will any other organisation benefit from your fundraising? If yes, please state the % split to The Christie and the other charity/ies which you have chosen to support?: I declare that I have read the fundraisers agreement - in aid of The Christie. Data protection statement By submitting your donation and personal information you agree to us recording your details on our database, so we can provide you with the best possible support every time you contact us. We will also contact you from time to time by phone, email, text or post to tell you about how we can support you and how you can get involved with our team. Your details will be kept securely and only shared with our suppliers or partners who work on our behalf or with us to deliver and improve services for people affected by cancer. We never sell or swap your details with third parties. If you prefer us not to use your details in this way, you can email email@example.com, telephone 0161 446 3988, or write to us at The Christie charity, 2-4 Candleford House, Manchester, M20 3JH.