2019 Event Registration If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Registration must be accompanied with payment to confirm your place. Challenger Information First Name * Last Name * Email * Confirm email address * Phone * Is this your first Brown Dog Challenge? If yes, do you have a connection with any of the organising team? If so, write their name in the box below: If no, where did you hear about us Website Facebook Other Which challenge do you want to join? * Wordsworth Scafell Latrigg Any medical conditions we should be aware of? (write none if you have none) * Next of kin name * Contact number of next of kin? (MUST BE DIFFERENT TO YOUR OWN NUMBER -for emergency only) * Are you doing the event with a partner or a friend, if so, please share their name: Are you happy for your details to be held by Brown Dog to enable us to keep you informed of future events and fundraising achievements? Yes No Terms and conditions It is really important that you read all the following terms and conditions before ticking the box below to accept them: I will be 18 or over on 20th June 2020. I agree to raise as much money as I possibly can. I agree to aim to raise as much money before the event as I can and as early as possible. I agree to use Virgin Money Giving to raise money (unless this is not practical or possible to me). I agree to read the information pack provided and regular communication messages from Brown Dog. I understand that I need to bring sufficient water (in line with quantities highlighted in the information pack) and food to get me through the challenge. I accept that Wordsworth and Scafell are not easy challenges and as such I agree to train for the event and get appropriately fit / prepared. I understand that I have to organise my own accommodation. I have read and agree to all of the terms and conditions above. * Payment Please confirm that you want to join the Dogs Dinner Celebration * Yes No Any special dietary requirements for the Dogs Dinner? (write none if you have none) * Which T-Shirt would you like to order? (See pictures below) Standard (included in price) Breathable t-shirt (+£6 extra) hhh hhh hhh hhh hhh hhh hhh hhh hhh What is your t-shirt size? (Included in event cost) * Small Medium Large Extra Large Extra Extra Large Total Cost: £75.00 Please confirm challenge and proceed to payment page by selecting the submit button. Are you planning on paying in full now or setting up a standing order? * Paying today in full Setting up a standing order **Please check your spam if you haven’t received the confirmation e-mail after you’ve pressed the above submit button
