Trek 4 Your Mosque - 19th to 20th July 2019
Please complete the registration form to participate in 'Trek 4 Your Mosque' 2019. You must answer all of the questions which apply to you.

What is your First Name? *
Please enter your first name below.
Your answer
What is your Surname? *
Please enter your surname below.
Your answer
What is your age? *
Please enter your surname below.
Your answer
Home Address *
Please enter your full home address below.
Your answer
Postcode *
Please enter your postcode.
Your answer
Telephone *
Please enter your telephone.
Your answer
Whatsapp Trek Group
Email *
Please enter your email address.
Your answer
Age *
Please enter your age. (This event is for men & boys only aged over 16)
Your answer
Emergency Contact
Next of Kin Name *
Please enter the name of a family member or close relative.
Your answer
Next of Kin Telephone *
Please enter next of kin telephone number.
Your answer
Health Details
It is the responsibility of the participant to be fit to compete on the day of the event. If you have any medical issues which you think may put you at risk when trekking, see your GP prior to registering.
Do you have any disabilities?
Please enter details of any disabilities.
Your answer
Your Health Status *
Please select your current health status
Do you have any of the following conditions?
Please select the issues that apply.
Other Condition
Please explain the condition below.
Your answer
Terms & Conditions
1. You must be able to finish the trek with the group. 2. Participants must compete trekking on foot. 3. You understand that you are participating entirely at your own risk. 4. The East London Mosque Trust (ELMT), its sponsors and suppliers, including local authorities and facilitating agencies will not be liable for any loss/damage, illness or injury whatsoever directly or indirectly, occasioned by or resulting from the negligence, wrongful act or any other cause of the participant. 5. The ELMT reserves the right at its absolute discretion to alter the date of the event or to change the published course as deemed necessary at any time and to alter without prior notice the contents of each race pack and event media partners. 6. I also hereby give permission to use my/our name, quotes, video footage and photographic likeness for marketing and promotional purposes. I also agree to the full Terms and Conditions as displayed for this event.
Agreement *
Please explain the condition below.
Required
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