Shine Bright - form test - St Peter and St James Hospice

Are you walking in memory of someone?(Required)

Yes

No

Please tell us the name of the special person you are walking in memory of:(Required)

Share your dedication or a special memory of the person(Required)

Adult

Price: £ 20.00

16 and under

Price: £ 10.00

Family of 5

Price: £ 60.00

Under 5's go free

Price: £ 0.00

Make an additional donation

Total

Are you able to Gift Aid your donation?(Required)

Yes

No

Would you like to register as an organisation?

Yes

No

Name of organisation

Names of Attendees & T-Shirts(Required)

Please enter names of all people who will be attending, including children and under 5's, and add the size of t-shirt they will need. Press the + button to the right to add more names.

First Name

Last Name

T-Shirt Size

Name(Required)

Email(Required)

Phone(Required)

Address(Required)

Street Address City County Postcode Country

Is this address the same one you would like your t-shirts delivered to?(Required)

Yes

No

Address for delivery of t-shirts(Required)

Street Address City County Postcode Country

Is this the same address as your billing address?(Required)

Yes

No

Address for billing(Required)

Street Address City County Postcode Country

Shine Bright - Register