London Marathon 2012 Pledge Form

London Marathon 2012
Pledge Form
I accept the challenge to participate in the Virgin London Marathon in April 2012 as part of
the Bede team.
If I am offered a guaranteed place, I pledge to raise a minimum of £2,000 for Bede House
Association (including Gift Aid and company match funding if appropriate).
I understand that the Marathon place granted to me has cost the charity £300 plus VAT and that
by starting the Marathon in April 2012 using the charity’s place, I will be honour-bound to deliver
the pledged amount whether from sponsorship or from my own resources in the event of a
shortfall. I further understand that I will be released from this pledge if I voluntarily surrender the
place to the charity before 22 February 2012. I agree to return all my sponsorship money to Bede
by the end of June 2012. I will be over 18 on 22 April 2012.
Signed ________________________________________ Date ______________________
Personal Details
Name:___________________________________________________________________________________________________
Address:________________________________________________________________________________________________
__________________________________________________________________________________________________________
___________________________________________
Postcode:________________________________________________
Daytime Tel:_____________________________
Mobile: _________________________________________________
E-mail: ________________________________________________________________________________________
Date of birth:________ /________ /________ Male Female
Registered Office: 351 Southwark Park Road, London SE16 2JW
Registered Company Number 420386. Registered Charity Number 303199

Company Information (if applicable)
Company name: _________________________________________________________________________________________
Type of Business: ________________________________________________________________________________________
Address:___________________________________________________________________________________________________
_____________________________________________________________________________________________________________
Postcode: ___________________________________________ Job Title:_________________________________________
Registration Fee
I would like to pay my registration fee of £20 by cheque (payable to Bede House Association)
which covers some up-front expenses and is a sign of my commitment to the charity.
I understand that my cheque will not be until my place is confirmed by Bede. Thereafter, this
fee is non-refundable in the event of my withdrawal prior to the race or in the event of my
getting my own place in the ballot.
Fundraising
What is your personal fundraising target? £
How will you raise this amount?
(Please provide as much
information as possible, as our
decision on whether we can offer
you a place on the team will be
based on this information.)
Registered Office: 351 Southwark Park Road, London SE16 2JW
Registered Company Number 420386. Registered Charity Number 303199

Fundraising, continued...
Why do you want to fundraise
for Bede?
Have you supported Bede in
the past?
Yes No
(If yes, please give details
opposite)
Have you ever run the
London Marathon before?
Yes No
(If yes, please give details
opposite)
Have you applied for your own place in the London Marathon? Yes No
I will be*/ will not be* providing my own running t-shirt
* Delete as appropriate
Additional Information
Please tell us how you found out
about running the London
Marathon on behalf of Bede
Bede would like to keep you informed about our events programme.
If you would prefer NOT to receive future information, please tick here.
Please complete all pages, print off this form, sign and return to Vivien Palmer, Bede House fax at 020 7394 7586 or by
post to Bede House, 351 Southwark Park Road, London SE16 2JW. For any queries, please call us on 020 7237 3881.
We will let you know whether we can offer a place as soon as we can!
Registered Office: 351 Southwark Park Road, London SE16 2JW
Registered Company Number 420386. Registered Charity Number 303199