British Gas Great North Swim application form

Fields marked with a * are mandatory

Title*:

First name*:

Surname*:

Name by which you would like to be known*:

House number/name*:

Postcode*:

Daytime telephone number*:

Mobile number:

Email*:

Please supply your email address for confirmation and further event information by email. You can unsubscribe at any time by emailing events@guidedogs.org.uk

Are you blind or partially sighted?

If yes, in which format would you like further information? BrailleAudioEmailLarge printRegular print

Employer:

Team members (if relevant)

Where did you find out about joining Team Guide Dogs?*

Other:

By completing and submitting this form I accept all the points stated in this Fundraiser Agreement

Do you agree to the declaration? *

Keeping in touch

We would like to keep you informed about Guide Dogs, its trading company, its activities, products and services and ways you can help. If you do not wish to receive this information, please tick this box

Any comments?