Skydive sign-up - Birmingham Hospice

Ticket (Required)

Price: £ 50.00

Total

Date of skydive(Required)

Please submit the date you have your skydive booked for. Please type ‘TBC’ if you need to confirm a date with the airfield.

Title

First name(Required)

Last name(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email address(Required)

Phone(Required)

Date of birth(Required)

I confirm that I am 18 years of age or over.

Do you have any medical conditions?(Required)

Height(Required)

Weight(Required)

Emergency contact name(Required)

Emergency contact number(Required)

Would you like a hospice branded t-shirt when hitting the £395 sponsorship target? If so, please select your size

I heard about Skydive from:

I am signing up for Skydive

Can we contact you about Marketing and PR (e.g., to feature in a case study)?

Yes

Do you want to pay for your own place?

Yes, I will pay an additional £180 on arrival at my Skydive, and 100% of sponsorship going to the charity.

No, I will raise a minimum sponsorship £395 and the charity will cover the remaining £180 for my skydive.

Would you like official skydive photos/video?

To be paid nearer to the time directly to the airfield in cash.

By signing up to this campaign, you are consenting to receiving ALL information about this campaign. We would ALSO like to keep in touch with you about our vital work and update you on our news and fundraising activities. Please tell us if you would be happy for us to contact you:

By email

By SMS

We may also contact you by telephone and/or post. If you wish not to be contacted by post or telephone, please tick here:

Opt out of telephone

Opt out of post

Terms and Conditions:(Required)

By signing up to this event I agree to the following T&C’s: In return for a charity skydive place, I agree to pay a £50 non-refundable deposit and EITHER raise £395 for Birmingham Hospice OR pay a final fee of £180 on the day of my skydive. I accept the responsibility to ensure that all fundraising monies/donations received in connection with this event are paid to Birmingham Hospice no later than six weeks after the event date. Under no circumstances will I give any of the money to any other organisation or individual. I accept that by signing up to this event I am consenting to receiving ALL information about this event, including a fundraising pack and sponsorship forms. I accept the responsibility of informing Birmingham Hospice should I wish not to receive event specific communications. I accept full responsibility for myself whilst participating in this event and understand that Birmingham Hospice cannot accept liability for any loss or damage to personal property, injury or death. I confirm I am aware of the height, weight, waist measurements and age limits for this challenge and if necessary sought medical advice from a doctor and sign off from my GP. I confirm that I am sufficiently fit and healthy to take part in this event. Should this change, I will seek medical advice prior to the event. I confirm that I am over the age of 18 years old, or that I am over 16 years old and have written consent from my parent or guardian. I take full responsibility for any costs attributed to my participation in this event and will not deduct any expenditure from funds raised. I accept that should I no longer be able to take part in this event, I will be unable to claim a refund for my registration fee. Any sponsorship collected will be refunded to the donor or gifted to Birmingham Hospice. I accept that if I can no longer take part, or the event is cancelled, there is no guarantee that my place will be rolled over, but the charity will endeavor to do so.

I agree with the terms and conditions

Total

Credit Card

Sign up to a skydive for Birmingham Hospice