Title*MissMrsMsMrMxDrProfOtherFirst name*Surname*Group name*Address*Postcode*Telephone numberEmail* Keep in touch*Birmingham St Mary’s Hospice would like to keep you updated about our work and how your support is making a difference. Please tick here if you would like to hear from us.Yes please, I’d like to hear from you by emailNo thanks, please don’t contact me by emailDate of birth Date Format: MM slash DD slash YYYY How did you hear about the campaign?*Why are you supporting the hospice?*Declaration* I agree to donate all of the proceeds from 40 Mile March to Birmingham St Mary’s Hospice with four weeks of the event taking place. Under no circumstances will I give any of the money to any other organisation or individual. Section BreakThank you so much for your support, it means a lot to all of us here at the hospice. We’d like to share with you the latest about our work, fundraising initiatives and ways to get involved…What are you interested in? Baking Children's activities Challenge events Running events Cycling events Hospice events Volunteering opportunities Regular giving Hospice news updates This iframe contains the logic required to handle Ajax powered Gravity Forms.