2020 Snowdon by Night Challenge Registration Form
Everton in the Community is a registered UK charity with the charity number 1099366.
Registrant Information
First Name:
Last Name:
Email Address:
Customer Number:
Mobile Number:
Date of Birth:
Twitter Handle:
Full Address inc. Postcode:
Medical Information
Emergency contact name :
Emergency contact number :
Do you have any medical conditions?:
Yes
No
Medical condition details :
Do you have any Dietary Requirements ?:
Yes
No
Dietary requirements details :
Declaration
I agree £20 registration fee and I will also commit to raising a minimum of £300 for Everton in the Community.
Card Information
Card Number
Expiration (Month)
Expiration (Year)
CVV Code
Cardholders Full Name
Cardholders Email Address