Join #TeamMyton and sign up to our Coventry Cathedral Abseil today! "*" indicates required fields Step 1 of 2 0% UNIQUE ID Your details... Your ticket* Price: Title* Mr Mrs Miss Ms Dr First name*Surname*Email* Mobile number*Are you over 18?* Yes No Are you over 16 on the day of this event?* Yes No We are sorry but you have to be over 16 years of age on the day of this event to take part.Date of birthDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Your address... Please enter your postcode and select your address*Address line 1*Address line 2Address line 3City / Town*CountyPostcode*This field is hidden when viewing the formCountry*Your Abseil... Preferred start time*Please indicate your preferred start time. We cannot promise that this will be your exact time but will do our best to make sure this is possible. 9.30 am10.00 am10.30 am11.00 am11.30 am12.00 pm13.00 pm13.30 pm14.00 pm14.30 pm15.00 pm15.30 pmEmergency contact name*Emergency contact number*Your welcome packIf you are able to download your welcome pack and/or print it yourself we would really appreciate it, this will save us a considerable amount of money on printing and postage as each pack costs around £3. We are also trying to ensure our events are as environmentally friendly as possible and cut down on unwanted waste so would appreciate your support with this. I am happy to download my welcome pack Please post my welcome pack to me at the estimated cost of £3 per pack to Myton I agree to raise a minimum of £200 in sponsorship* Yes, I agree Would you like to purchase a Myton T-shirt for just £6?... Would you like a Myton T-shirt? Myton Cotton T-shirt - £6 No Thank You Please select your size* Adult S Adult M Adult L Adult XL Adult XXL Is your payment information the same as your participant details entered above?* Yes No First name on Debit or Credit Card*Surname on Debit or Credit Card*Address line 1*Address line 2City / Town*Postcode* Where did you hear about this event?*You can select multiple Email Facebook Flyer Friends, family or word of mouth Instagram Lamp post sign Newspaper / Magazine Myton shop Myton's website Other website Poster Roadside banner Twitter Other Why are you supporting Myton?*You can select multiple In memory Thanks for care Hospice movement Local charity Other Please let us know the first name of your loved one*Please let us know the surname of your loved one*Please let us know their relationship to you*Why are you supporting Myton?*Like all hospices, we are deeply concerned about the current funding crisis for our services. With costs at an all-time high, we need your support now more than ever to continue providing our care free of charge to patients and their loved ones.. Do you wish to make an optional donation in lieu of sponsorship? Donate £28 could fund one hour of specialist nursing care £84 could fund the cost of three hour’s specialist nursing care £168 could fund the cost of six hour’s specialist nursing care £224 could fund the cost of eight hour’s specialist nursing care £336 could fund the cost of 12 hour’s specialist nursing care £672 could fund the cost of 24 hours specialist nursing care £1,064 could fund the cost of one week of specialist nursing care A gift of my choice No thank you Please enter your amount*If you have clicked an amount by mistake you can enter "0" if you wish not to add a donation.... I wish to Gift Aid my donation and increase its worth by 25% at no cost to me I am a UK tax payer and confirm I will pay an amount of UK income tax or Capital Gains tax for each year that is at least equal to the amount of Gift Aid that all charities that I donate to will reclaim on my behalf. I understand that if I pay less Income Tax/Capital Gains Tax in any tax year than the amount claimed on my donations, it will be my responsibility to pay any difference back.Please select the appropriate statement* Yes claim Gift Aid for the last four years /and any I may make in the future, until I notify you otherwise Yes claim Gift Aid for my latest donation /and any I may make in the future, until I notify you otherwise I am NOT a UK taxpayer or do not wish to Gift Aid my donations This field is hidden when viewing the formGA Date Four YearsThis field is hidden when viewing the formGA Date today DD slash MM slash YYYY This field is hidden when viewing the formGA No Date DD slash MM slash YYYY Find out the difference your support makes... Thank you for supporting The Myton Hospices so we can continue to provide our services free of charge to people, and their families, living with terminal illnesses. We may keep in touch with you by post and phone to tell you more about our vital work and other ways you can help, including opportunities to donate, fundraise or volunteer and how your support has made a difference. Please let us know if you’re also happy to hear from us by email and text: By email* Yes No By text* Yes No Event Registrations T&C's... Contact details provided (including email address and telephone number) are used to keep you up to date about the event you are taking part in and support you in your fundraising efforts where appropriate We may ask for next of kin details in case of an emergency. All details will be stored securely and are used in relation to the event you are taking part in. Please ensure that you are physically in person with any team members you sign up to this event and have full consent to share their details with us. If you are not their registration may be invalid. Also, please ensure that you read a full copy of our terms and conditions for this event by clicking here. Your privacy... We promise to do our best to keep your details safe and secure and will only process your data in accordance with the current Data Protection legislation. Our Privacy Policy explains how we keep this promise and you can read more online at www.mytonhospice.org/privacy-policy If you change your mind about hearing from us please email DSCT@mytonhospice.org or call us on 01926 358383. I have read and accept The Myton Hospices Terms and Conditions for this event* I accept I have read and accept The Myton Hospices Privacy Policy* I accept Total This field is hidden when viewing the formDONThis field is hidden when viewing the formTSHIRT
