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Fundraising
>
Event Volunteer Enquiry
Event Volunteer Enquiry
Title
*
Full Name
*
Surname
*
Gender
*
Male
Female
Date of Birth (dd/mm/yyyy)
*
Full Address
*
Line 1
*
Line 2
Town
*
County
Postcode
*
Country
Afghanistan
Albania
Algeria
Angola
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Rep of
Congo, Rep.of (Brazzaville)
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia, The
Georgia
Germany
Ghana
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Guam
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Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
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Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos, People Democratic Rep.
Latvia
Lebanon
Lesotho
Liberia
Libyan Arab Jamahiriya
Liechtenstein
Lithuania
Luxembourg
Macau, China
Macedonia (FYROM)
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Samoa
San Marino
Saudi Arabia
Senegal
Serbia Montenegro (SRBIJA)
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Is.
Somalia
South Africa
Spain
Sri Lanka
Sudan
Surinam
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad
Tunisia
Turkey
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States of America
Uruguay
Uzbekistan
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Telephone Number
*
Email Address
*
Select type of event you wish to help with
+
Centre Stage 2012 Heats, 16th- 20th April, Wardrobe Leeds
Anniversary Games, 22nd April, The Grammar School at Leeds
Leeds Half Marathon, 13th May, Leeds City Centre
Dragon Boat Race, 20th May at Roundhay Park
Jane Tomlinson's Leeds 10k Run, 8th July
Centre Stage 2012 Final, 17th July at O2 Academy Leeds
Jane Tomlinson's York 10K Run, 5th August
Jane Tomlinson's Walk For All, 19th August, Settle
The White Rose Centre various times and dates
T Shirt Size
*
Small
Medium
Large
Extra Large
Personal Declaration
*
I acknowledge that I am volunteering entirely at my own risk and that Martin House Children's Hospice shall not be liable in any way for any injury or loss that might occur as a result of my activities other than as a result of Martin House negligence
I agree that Martin House Children's Hospice may hold and use the data on this form for the database and futher volunteering opportunities.
Do you have any health problems or disabilities that we should be aware of? If yes please give details
?
Do you have any criminal convictions, if yes please give details
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