Join up for 'Just Walk' Charity Hike

Just Walk 2009 Join Up Form
Please complete the form below. All questions marked with an * must be completed. On submission, you will be re-directed to our secure payment system where you will be asked to pay your event fee.

*Title

*First Name
*Last Name

*Date of birth

*Event

*Mobile number on the walk

*Email Address
All event information and newsletters will be sent to this email address

Address
Postcode

*Chosen Charity or fund

Contact email address at chosen charity

What is your target fundraising amount?	£

*How did you find out about Just Walk?

*Do you have any medical conditions or do you take any medication? Please give details.	Yes No

All medical information will be treated as confidential

Do you have any special dietary requirements?	Yes No
	Yes No

	Please tick this box to indicate that you have read and agree to the terms and conditions.

	All event information, the event pack and newsletters will be sent to the email address provided. If you don't receive anything, please contact Gemma on 01460 30456

Just Walk terms and conditions

By ticking the box you agree to the following terms and conditions;

Children under 18 years of age on the day of the event must be accompanied by a responsible adult who is also registered to participate in the event. Under 18’s may only take part in the 20km walk unless given written permission by the event organisers Across the Divide

I agree to pay the fee stated in the Join Up form and agree that this fee is 50% refundable up until 28 days prior to the event, after which it is non refundable.

As a participant I must provide any relevant medical information. This information will be treated in confidence and only used for this event. Across the Divide (ATD) have the right to refuse entry to anyone deemed medically at risk in taking part in this event.

I agree that I am in good physical condition and accept that this challenge is strenuous and that ATD take no liability for injuries or ill health resulting from participation in this event

The Event Manager may at any time during the event terminate my participation if it is considered necessary for the health and safety of other walkers, and/or myself or if I commit an illegal act

I am taking part in this event at my own risk and will not indemnify ATD or its suppliers or anyone acting on their behalf for any risk, damage, loss or costs arising as a result of my participation

Prior and during the event I will be responsible for my own safety and will take all reasonable care to ensure the safety of others and will comply promptly with any safety instructions given by ATD or any person acting on their behalf

Just Walk 2009 Join Up Form