Carrots NightWalk

Step 1 – your details

Please register each adult separately. Under 18s must be registered together with the accompanying adult. Teams: If you are taking part as part of a team, e.g. a group of friends, please ask each member of the team to include your team name on their registration.

If you have any questions, please call the events team on 020 7264 3900 or email events@fightforsight.org.uk.

= mandatory field
Personal details
Mandatory field Title*
(other)
Mandatory field First name*
Mandatory field Surname*

Mandatory field Email address*
Mandatory field Phone number*

Mandatory field Address line 1*
Address line 2
Mandatory field Town/City*
Mandatory field Postcode*
To submit this form you must be at least 18 years old. Please confirm your birth date:
Mandatory field Your birth date*
What is your T-shirt size? (T-shirts will be issued on the night for you to wear on the walk. Please select the appropriate size, bearing in mind that this may be worn over a layer of clothing.)
Mandatory field *
Anyone under 18 accompanying you must be registered on this form. If this applies to you please tick this box to provide their details:


Choice of route
Which route would you would like to register for? The minimum age for the 15 mile route is 13, while a shorter 6 mile route is open to all ages. See further information about routes
Mandatory field Distance*	15 mile route 6 mile route
Team entries
If you are entering as part of a team, e.g. a group of friends, you may provide the name of your team. (If you are part of a Company Sponsored Team your team co-ordinator will register you.)
Team name/friend name
Choose where your money goes
Your sponsorship money will support our vital programme of eye research. If you would like to support a specific area of our work please specify here:

What else we need to know
Do you or any under 18s named on this form have any medical conditions or accessibility and/or mobility needs which we should be aware of?
	Yes


Who should we contact in case of an emergency?
Mandatory field Name*
Mandatory field Phone number*
Do you know anyone who may be able to volunteer as a marshal on the evening?
Name
Phone number
Will your employer match the funds you raise?
	Yes
Please tell us how you've heard about this event:
Mandatory field *

Email newsletter
Would you like to receive our email newsletter sent every two months?
	Yes
Terms and conditions
I confirm that I have read and understood the terms and conditions for Carrots NightWalk – See London in the Dark 2012.
Mandatory field *	Yes


Details of under 18s
Please give the names and ages (on 21 September) of anyone under 18:

Mandatory field First name*
Mandatory field Surname*
Mandatory field Age*
T-shirt size (if required)

First name
Surname
Age
T-shirt size (if required)

First name
Surname
Age
T-shirt size (if required)

First name
Surname
Age
T-shirt size (if required)

First name
Surname
Age
T-shirt size (if required)

Registration

Step 1 – your details

Personal details

Details of under 18s

Choice of route

Team entries

Choose where your money goes

What else we need to know

Email newsletter

Terms and conditions