* Required field
I have my own place in the 2006 Flora London Marathon.
Yes
No
Name:*
Address 1:*
Address 2:
Address 3:
Town:*
County:
Postcode:*
Home telephone:*
Work telephone:
Mobile:
Email address:
Preferred method of contact in addition to mail: email phone either*
How did you hear about our involvement in the event (please select from the following)
What is your fundraising target for the event?
If yes, which company? Please state
Vest size: Small Medium Large Extra Large*
If you have any problems please contact: Kate Glasgow, The London Marathon Team, The Stroke Association, Freepost, LON 13015, London, EC1B 1BR. Telephone: 020 7566 1524.
