Complete a registration form and our team will be in touch to secure your charity place in your chosen event First Name Last Name Email Mobile fieldset1 Date of Birth Home Address Address Line 2 Address Line 3 Address Line 4 City Post Code Country CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua & BarbudaArgentinaArmeniaArubaAscension IslandAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia & HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicCeuta & MelillaChadChileChinaChristmas IslandClipperton IslandCocos (Keeling) IslandsColombiaComorosCongo - BrazzavilleCongo - KinshasaCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d’IvoireDenmarkDiego GarciaDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard & McDonald IslandsHondurasHong Kong SAR ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao SAR ChinaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorth MacedoniaNorwayOmanOutlying OceaniaPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSamoaSan MarinoSarkSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia & South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSt. BarthélemySt. HelenaSt. Kitts & NevisSt. LuciaSt. MartinSt. Pierre & MiquelonSt. Vincent & GrenadinesSudanSurinameSvalbard & Jan MayenSwedenSwitzerlandSyriaSão Tomé & PríncipeTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad & TobagoTristan da CunhaTunisiaTurkmenistanTurks & Caicos IslandsTuvaluTürkiyeU.S. Outlying IslandsU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWallis & FutunaWestern SaharaYemenZambiaZimbabweÅland Islands fieldset3 What's your connection to cardiomyopathy? fieldset2 - Select -I have cardiomyopathy or a related conditionI am a friend/family member of someone with cardiomyopathyI would like to support the charity in memory of a loved oneCardiomyopathy UK is my employers charityI am a healthcare professionalOther fieldset4 We love to get to know our fundraisers so please tell us about yourself and your reasons for supporting Cardiomyopathy UK Event Tell us about your fundraising plans to raise the minimum fundraising amount? I understand that my place is not confirmed until the registration fee has been paid.? Yes Once we've received your registration, our fundraising team will contact you with a link to pay your registration fee. Running vest/cycling jersey size - Select -XSSMLXLXXL Would you be interested in sharing your story to support and inspire others? Yes This could be in our My Life magazine, on social media or as part of one of our campaigns. Would you like to receive email updates from us about the latest support and information for people affected by cardiomyopathy, our campaigns, research and ways to get involved?? Yes No I agree to the charity event place terms and conditions - click to view. Participation I will inform the fundraising team immediately if I have to withdraw from or cancel my place due to injury or other serious circumstances. I agree that if I withdraw for any reason prior to the event, any monies raised will be non-refundable and will be treated as a donation to Cardiomyopathy UK. I will make donors aware of what happens to their donations if I fail to complete the event. I understand that if I withdraw for any reason prior to the event, Cardiomyopathy UK cannot guarantee to grant me a place in future events. Where I am aware of cardiomyopathy or a related condition affecting myself or a family member, or if I have a cardiac device fitted, I understand that Cardiomyopathy UK’s advice is to seek cardiac screening and speak to my doctor before taking part. I understand that Cardiomyopathy UK may be unable to grant me a place if upon medical guidance, the Charity does not feel it is safe for me to participate. I understand that Cardiomyopathy UK reserves the right to revoke my event place in exceptional circumstances. I understand that this event is organised by the event organiser who is solely responsible for the conduct and operation of the event, including all health and safety requirements. I understand that my participation in the event is conditional upon the event organiser’s terms and conditions. I understand that Cardiomyopathy UK is not responsible for the event and accepts no liability whatsoever in relation to my participation in it. I understand that Cardiomyopathy UK will contact me by phone, email and post to provide everything I need for my chosen event, including fundraising tips and advice, useful updates about the event and training support. I confirm that I will be at least the minimum age required by the event organiser at the date of the event. Fundraising activity I agree to raise the minimum sponsorship amount for Cardiomyopathy UK (*excludes any gift aid) by the fundraising deadline, which is 6 weeks after the event date. I will only use lawful means to fundraise and will not do anything that is likely to bring Cardiomyopathy UK into disrepute. If any funds intended for the charity are raised and paid to me, I will pay it directly to Cardiomyopathy UK through the payment methods they suggest. I will abide by the Fundraising Regulator’s Code of Fundraising Practice I will show the charity any material bearing the Cardiomyopathy UK name or logo, or that discusses the work of the organisation, prior to printing and distribution. Personal data and images I give permission for the free use of my first name, picture, image, feedback and comments in any future fundraising materials and/or promotion conducted by Cardiomyopathy UK. I give permission for my personal information to be stored and used by Cardiomyopathy UK in connection with the organisation and administration of the Event and passed to the Event organisers as required. I understand that Cardiomyopathy UK will process my data in accordance with their Privacy Policy.