Moonlight Colourthon

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In 2011...
Charities Registered

Charities were nominated for the 2011 Colourthon!

Please complete the online form below making sure to complete all fields.

Once completed you will be directed to our Secure PayPal page to pay your registration fee, you can pay using any of the following methods:-

Please note: There is a small fee payable for using method of payment, this represents the administartion costs associated with using this service. As a non-profit making event we could not afford to cover these additional costs.

* All these fields must be completed.

Registrant Details

I would like to become a member of the 'Colourthon Events' and participate in:-

Please Note: The Moonlight Colourthon is only open to entrants aged 16 and above as at midnight on the 01/07/2011. Entrants for the Sunlight Colourthon under the age of 13 must be accompanied by a Parent/Guardian.

* Select Colourthon Event

Your Details

* Title

Mrs

Miss

Other

* Forename(s)

* Surname

* Date of Birth

* Address Line 1

Address Line 2

* Town

* County

* Postcode

* Country

Home Phone

Work Phone

Mobile Phone

* Emergency Phone

* Email

Disabilities

Nominated Charity Details

Please select a charity from the drop down menu. If your charity is not listed please select (OTHER) from the bottom of the menu and complete the New Charity section below.

You can search for your Registered Charity details at the Charities Commission
www.charity-commission.gov.uk

* Nominated Charity

New Charity

Please complete this section if your charity is not listed above. You must complete all the following fields with your nominated charity's full details.

You can find information on your Registered Charity at the Charities Commission
( www.charity-commission.gov.uk )

Charity Name

Charity No

Charity Address

Charity Address 2

Charity Town

Charity County

Charity Postcode

Charity Phone No

Charity Fax No

Charity Email

Charity Informed

Charity Informed (Please Tick)

Gift Aid

Use 'Gift Aid' and you can make your donation worth more. If you have paid Income Tax in the United Kingdom in the past year, for every £1 you give us we can claim an extra 28p from the Inland Revenue. If applicable please tick the Gift Aid box.

Please claim 'Gift Aid'

Estimated Time

It would help us to know your estimated time to complete the Moonlight Colourthon (half Marathon) walk

Estimated Time to Complete

T-Shirt

Please select your T-Shirt size.
(You get one T-Shirt with entry to the 'Moonlight Colourthon' only)

* Size (Please select one)

None

XXL

Where did you hear about the Colourthon?

It would help us to know where you heard about the Colourthon Events. Please select an option from the drop down menu below or select (OTHER) and detail in the box below.

* Heard about Colourthon

(OTHER)

I confirm that I have read and agree to the Rules and Conditions of the 'Colourthon Events'

* Please tick box to confirm

The 'Moonlight/Sunlight Colourthon' are fundraising events organised by 'The Moonlight Colourthon Charitable Trust' on behalf of Southend Round Table 106.
Both events are run on a totally voluntary basis by its Trustees.