MHA London Marathon 2016 Application Form

Closing date 30 October 2015

Thank you for taking time to complete our application form. A member of the Fundraising Team will be in touch shortly after the closing date to let you know if your application for the Virgin Money London Marathon 2016 has been successful.

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* 1. Could you please provide your contact details.

Name

Address

Address 2

City/Town

Postal Code

Email Address

Phone Number

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* 2. We have one place available for the 2016 London Marathon.

We are asking our 2016 runner to raise a minimum of £3000, preferably more. This can include Gift Aid and any matched funding from your employer.

Are you up for the challenge to reach this goal to help us support even more older people?

Yes

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* 3. Have you participated in a similar event in the past?

Yes

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* 4. If you answered yes to question 3, could you please provide the following information:

How much sponsorship did you raise?

What was the event?

When was the event?

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* 5. Do you have any fundraising experience?

Yes

Please provide details of any fundraising activities you have participated in.

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* 6. Please select your estimated running time from the following options:

0 - 3 Hours

3 - 4 Hours

4 - 5 Hours

6 + Hours

I do not know my estimated time.

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* 7. Which of these best describes your knowledge of MHA?

I am a current member of staff

I am a current volunteer for MHA

I have previously worked for MHA

I have previously volunteered for MHA

I am a current MHA fundraiser or supporter

I have previously been a MHA fundraiser or supporter

I have a friend or relative who is a MHA resident or Live at Home member

I have a friend or relative who has previously been a MHA resident or Live at Home member

I'm new to MHA

Other (please specify)

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* 8. How did you hear about the opportunity to take part in the London Marathon for MHA?

The MHA website

In MHA's free magazine 'Heart & Soul'

Via a MHA Care Home, Retirement Living or Live at Home Scheme.

On social media

In MHA's internal newsletter 'Staff Matters'

Through a running club

Other (please specify)

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* 9. MHA also take part in similar events such as the Great North Run, would you like us to keep you informed about similar opportunties?

Yes