London Marathon 2012 Pledge Form
London Marathon 2012 Pledge Form
London Marathon 2012 Pledge Form
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<strong>London</strong> <strong>Marathon</strong> <strong>2012</strong><br />
<strong>Pledge</strong> <strong>Form</strong><br />
I accept the challenge to participate in the Virgin <strong>London</strong> <strong>Marathon</strong> in April <strong>2012</strong> as part of<br />
the Bede team.<br />
If I am offered a guaranteed place, I pledge to raise a minimum of £2,000 for Bede House<br />
Association (including Gift Aid and company match funding if appropriate).<br />
I understand that the <strong>Marathon</strong> place granted to me has cost the charity £300 plus VAT and that<br />
by starting the <strong>Marathon</strong> in April <strong>2012</strong> using the charity’s place, I will be honour-bound to deliver<br />
the pledged amount whether from sponsorship or from my own resources in the event of a<br />
shortfall. I further understand that I will be released from this pledge if I voluntarily surrender the<br />
place to the charity before 22 February <strong>2012</strong>. I agree to return all my sponsorship money to Bede<br />
by the end of June <strong>2012</strong>. I will be over 18 on 22 April <strong>2012</strong>.<br />
Signed ________________________________________ Date ______________________<br />
Personal Details<br />
Name:___________________________________________________________________________________________________<br />
Address:________________________________________________________________________________________________<br />
__________________________________________________________________________________________________________<br />
___________________________________________<br />
Postcode:________________________________________________<br />
Daytime Tel:_____________________________<br />
Mobile: _________________________________________________<br />
E-mail: ________________________________________________________________________________________<br />
Date of birth:________ /________ /________ Male Female <br />
Registered Office: 351 Southwark Park Road, <strong>London</strong> SE16 2JW<br />
Registered Company Number 420386. Registered Charity Number 303199
Company Information (if applicable)<br />
Company name: _________________________________________________________________________________________<br />
Type of Business: ________________________________________________________________________________________<br />
Address:___________________________________________________________________________________________________<br />
_____________________________________________________________________________________________________________<br />
Postcode: ___________________________________________ Job Title:_________________________________________<br />
Registration Fee<br />
I would like to pay my registration fee of £20 by cheque (payable to Bede House Association)<br />
which covers some up-front expenses and is a sign of my commitment to the charity.<br />
I understand that my cheque will not be until my place is confirmed by Bede. Thereafter, this<br />
fee is non-refundable in the event of my withdrawal prior to the race or in the event of my<br />
getting my own place in the ballot.<br />
Fundraising<br />
What is your personal fundraising target? £<br />
How will you raise this amount?<br />
(Please provide as much<br />
information as possible, as our<br />
decision on whether we can offer<br />
you a place on the team will be<br />
based on this information.)<br />
Registered Office: 351 Southwark Park Road, <strong>London</strong> SE16 2JW<br />
Registered Company Number 420386. Registered Charity Number 303199
Fundraising, continued...<br />
Why do you want to fundraise<br />
for Bede?<br />
Have you supported Bede in<br />
the past?<br />
Yes No <br />
(If yes, please give details<br />
opposite)<br />
Have you ever run the<br />
<strong>London</strong> <strong>Marathon</strong> before?<br />
Yes No <br />
(If yes, please give details<br />
opposite)<br />
Have you applied for your own place in the <strong>London</strong> <strong>Marathon</strong>? Yes No <br />
I will be*/ will not be* providing my own running t-shirt<br />
* Delete as appropriate<br />
Additional Information<br />
Please tell us how you found out<br />
about running the <strong>London</strong><br />
<strong>Marathon</strong> on behalf of Bede<br />
Bede would like to keep you informed about our events programme.<br />
If you would prefer NOT to receive future information, please tick here. <br />
Please complete all pages, print off this form, sign and return to Vivien Palmer, Bede House fax at 020 7394 7586 or by<br />
post to Bede House, 351 Southwark Park Road, <strong>London</strong> SE16 2JW. For any queries, please call us on 020 7237 3881.<br />
We will let you know whether we can offer a place as soon as we can!<br />
Registered Office: 351 Southwark Park Road, <strong>London</strong> SE16 2JW<br />
Registered Company Number 420386. Registered Charity Number 303199