Individual Registration

You are about to register for an individual account for the 24 Seven Challenge. The entry fee for an individual is £75. Please complete the form below. Once you have registered and completed the Google online payment, you will be sent an email confirming your entry. Your account will be activated once payment has been received.

Account Details

Title: *

Forename: *

Surname: *

D.O.B: (dd-mm-yyyy) *

Email: *

Confirm Email: *

- -

Profile URL: *

www.24sevenchallenge.co.uk/ (no spaces or spec. characters)

Account Password: *

Verify Password: *

Event Information
How did you hear about this event? *		how...
Reason for taking part? *	reason...
Wish to promote event? *
I am willing to take part in event publicity

If you have an interesting/inspiring story to tell or if you or your friends have been helped by CLIC Sargent, please tell us here...

Personal Details

Address Line 1: *

Address Line 2:

Address Line 3:

Address Line 4:

Town/City: *

County: *

Postcode: *

Country:

Telephone: *

Mobile:

Contact Preference: *

Gender: *

Shirt Size: *

(optional)

	If you do not want CLIC Sargent to post or email information to you about other Challenges or Running Events please tick this box
	If you do not want CLIC Sargent to post information to you about our work please tick this box
	If you do not want CLIC Sargent to send you emails about our work please tick this box
	If you do not want CLIC Sargent to share your details with other organisations please tick this box

	I have read, and agree to, the terms and conditions of entry.*

* indicates required field.

Registered charity number 1107328