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Healthy Heart Month Prize Draw
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1.
Name
(Required.)
*
2.
Is the entrant a service user or staff member?
(Required.)
Service User
Staff Member
3.
Contact Name (if different)
*
4.
Contact Email
(Required.)
*
5.
Would the entrant like to be entered into the prize draw for a chance to win a Smart Watch?
(Required.)
Yes
No
*
6.
Does the entrant consent to having their name and photographs shared publicly?
(Required.)
Yes
No
*
7.
Has the entrant chosen to try three different types of exercise or raise money for British Heart Foundation?
(Required.)
Exercise
Raise money
8.
If
exercise
, please write down the three different types of exercise.
1.
2.
3.
9.
If
raise money
, what did the entrant do?
*
10.
Please upload photos of the entrant trying three different exercises or evidence that the entrant has raised money for British Heart Foundation.
Please ensure you have taken the highest quality picture you can, with good lighting.
(Required.)
Choose File
No file chosen
11.
Additional Photo
Choose File
No file chosen
12.
Additional Photo
Choose File
No file chosen
13.
Any other information about your exercise activities or fundraising.
