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Refugee Action Charioke Marathon 2011

A green microphone and the words Charioke marathon - sing it like you mean it

This is an application for a Refugee Action place in the 2011 Charioke Marathon, held at Karaoke Box, Smithfield. Please complete this form as fully as possible and email to our Fundraising and Communications Assistant, Sally Cole-Hamilton at sallyc@refugee-action.org.uk by 11 February 2011.

Before registering, please read our terms and conditions

Please note * indicates a mandatory field.

Terms & conditions

YES I confirm that I have read and agree to Refugee Action?'s Charioke Marathon 2011 terms and conditions *

Your information

Title: * Please specify other:

First name:
Last name:
Address:
Town:
County:
Country:
Postcode:	* (For UK addresses only)

Please provide us with the best telephone number(s) on which to reach you. Please provide at least one number.

Telephone number 1: *

Telephone number 2:

Please provide your age at the time of the event. Participants must be aged 18 years or over at the time of the event.

Age: *

We will inform you by email if you are successful or unsuccessful in your application so please provide an email address that is checked regularly. By providing your email address you are also agreeing to receive communications about our projects and activities. You can unsubscribe easily at any time, and we will not share your details with any one else.

Email: *

About you

Occupation:
Employer:

Does your employer run a matched giving scheme where they will contribute an additional percentage of how much you raise? Please give details of up to how much they will match:

Why do you want to Charioke for Refugee Action?

Are you or any of your family members or friends refugees?
If YES, please give details:

Do you have special requirements we need to know about?
If YES, please specify:

Entry fee and fundraising pledge

I would like to apply to take part in the 2011 Charioke Marathon for Refugee Action. If offered a place, I am aware that I will need to pay a £10 entry fee and pledge to raise a minimum of £400 *

Please tell us your fundraising plans
How do you plan to raise the £400 pledge? *

I pledge to raise * (Minimum £400)

Is there anything about your participation that might make a good story for the media? (Are you a refugee? Have you overcome any particular challenge in order to run? Are you running for a particular reason?)

Where did you find us?

Finally, please indicate which of the folling first prompted you to get in touch with us?

If you selected 'Other' or 'Online forum' please specify:

All done? Send us your application

Thank you for your application!
We'll get back to you very soon.

Please note: We will not disclose your details to anyone else.