WSPA City Stampede : Register

Register
(* indicates required information)
Fundraising Goal: *

Title: *
First Name: *
Surname: *
Address 1:*
Address 2:
Address 3:
Town: *
County: *
Country: *
Postcode: *
Telephone Number (Daytime): *
Mobile Telephone:
Email Address: *
Occupation:
Employer:
Do you have any dietary requirements?
How did you hear about the City Stampede?
Chosen length of route:
I would like to be a:
Costumes will be posted out to you during April. If you would like to provide an alternative delivery address to the one above please enter it here.
Address 1:
Address 2:
Address 3:
Town:
County:
Country:
Postcode:
Would you be happy to be profiled for your local media?
Data Protection:	I do not wish to receive any future communications from WSPA or WSPA Trading
Please read and accept the waiver to proceed with registration: *	I understand and accept that there is a risk of injury as with any run and acknowledge that this is not a race. I accept that WSPA cannot be held responsible for personal injury, accident, loss, damage or public liability. If I am between the ages of 14 and 16 I will be accompanied by a responsible adult.
	I have read and agree to the waiver.