Registration

Florence Moo will be putting her best hoof forward on 16th July 2011 to complete the third MK Midnight Moo.

To register for MK Midnight Moo 2011 simply fill out the details below, click on the "Go to Online Payment" button where you'll be able to pay your registration fee of £15.

Title:

(required)

First Name:

(required)

Surname:

(required)

Home Address:

(required)

Town:

(required)

County:

(required)

Postcode:

(required)

Day time Tel No.:

(required)

Mobile No.:

(required)

Your Email:

(required)

I am taking part as part of a team:

Enter the team name or organisation you are representing

Emergency contact name:

(required)

Emergency contact number:

(required)

T-shirt size

S M L XL

Under 18

Age

16-24 25-40 41-60 61+

I agree to my name/photo being included in press:

How did you hear about MK Midnight Moo

Flyer Radio Website Newsletter Other

Other:

Please tick if you are an existing Hospice supporter:

I have read and understood the terms and conditions:

Total: £15.00

Data Protection Act 1998

Willen Hospice (and Willen Hospice Ventures Ltd) holds supporter information for use in connection with activities including fundraising. We may contact you by post, telephone or electronically.

If you would prefer not to be contacted please tick here:

Terms and Conditions

These conditions have been put in place to ensure the safety of all walkers taking part in this event:
1. I understand that this walk is not a race.
2. I understand that I will be walking along public roadways and redways at night and this in itself is potentially hazardous.
3. I am aware that Willen Hospice, their employees and volunteers cannot be held responsible for any personal injury, accident, loss, damage or public liability.
4. I understand that my registration fee is not refundable and that my place is not transferable.
5. I understand that I should be of reasonable health and fitness to undertake this challenge.
6. I understand that I have to be 16 or older to take part in this event.
7. I understand that if I am 16 or 17 years of age I must be accompanied by an adult who is a registered participant of the MK Midnight Moo.
8. I understand that I must not be under the influence of intoxicating liquids or illegal recreational drugs whilst taking part in the event.
9. I understand that I need to take safety precautions, including but not limited to wearing appropriate clothing, walking in a group, bringing a torch and water to the event.
10. I am aware that the route may involve some residential areas and my behaviour must be considerate of the local residents.