Registration

Your details

Title*

First name*

Surname*

Email*

Please confirm your email address*

Telephone (day)*

Mobile

Date of birth*

House number*

Address*

Address2

Address3

Town/city*

County

Postcode*

About your event

Event name or description *

Venue

Event date

Please select from the drop down list the type of event that best describes your fundraising activity *

Is anyone else fundraising with you through the event? Yes No

If yes, how many people?

Are you Fundraising with a group? Yes No

If yes, who are you fundraising with?

Please enter their name(s) and email address(es) if they'd like to be contacted by us

How much do you aim to raise through this event? £

Please include further details about your planned fundraising activity below, and any specific support you'd like to receive from us

Are there any other charities benefiting from your event? If yes, which charities?

Do you have any other requests at this stage?

Free Mind top

Please select if you would like a top to wear and we'll send this to you in time for the event

Size

We'll send you iron on letters so that you can add your name to the front of your event top. If you'd like this lettering, please enter a name to add to your top (this is for running events so people can cheer you on).

More about you

Have you taken part in an event for Mind before? If yes, please let us know which event this was in the space provided. Yes No

Previous event details

Do you have experience of mental health issues?

Please use this space to provide us with any further information about your reasons for supporting Mind

Are taking part in this event in memory of a loved one? Yes No

If you are, what relation is this person to you?

What is the person’s name?

Do you have a story that will inspire others? Mind is always looking for newsworthy articles. If so, would you be happy for our press team to contact you? Yes No

Marketing & T&Cs

How did you hear about Mind’s involvement with this event?*

I understand that I am undertaking this fundraising event at my own risk and Mind shall not be liable in any way for any damage, harm or loss that might occur from my event. I also agree to follow the guidelines set out in Mind's fundraising Guide in relation to branding, lotteries, raffles, insurance and fundraising law. I will endeavour to obtain and pay to Mind all monies raised within 4 weeks of my fundraising event and understand that any funds raised through this event will support the work of National Mind.

We would also like to keep you up to date with Mind's work, and details of other activities (including fundraising).

Please tick this box if you would like to receive this information via email.

Please tick this box if you would prefer to be contacted by post or telephone.

I understand that any information provided by me in connection with Mind may be recorded and used by Mind in accordance with the Data Protection Act 1998

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