If you would like to have priority on our waiting list, you can opt to pay a refundable deposit/full registration fee.
First Name *
Your answer
Surname *
Your answer
Email *
Your answer
Contact Number *
Your answer
Age *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Address *
Your answer
City *
Your answer
Postcode *
Your answer
Gender *
Any medical conditions we should know about? *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Number *
Your answer
Accomodation is based on twin sharing rooms. If you are registering with a friend or family member, please tell us the name of person you wish to share with. *
Your answer
How did you hear about this challenge? *
Required
What is your personal fundraising target? *
Does your employer have a match giving scheme? *
Any other comments?
Your answer
I am happy for Penny Appeal to contact me with updates for future events and activities. (please tick box)