PRALINE’S WALK  2012      REGISTRATION FORM

 Please join us for this Charity walk …..We would love to see you.
 If you can't, we would be grateful if you could make a donation. Thanks.

Thank you for completing this Registration Form. Sign it and return it by post/e-mail.  
 
NAME:____________________________ EMAIL:___________________________

ADDRESS:__________________________________________________________

___________________________________________________________________

TELEPHONE:_________________________.MOBILE:_______________________

  Please tick the relevant boxes below 
 
[ ]  WALKER: I would like to take part in the walk on Sunday 8th of January 2012.

       Fee :  £ 10

       I am being sponsored : £ ___________________( to be advised later ) 

 I understand that I take part in this event at my own risk, and that Praline’s Walk organisers  cannot be held responsible for any loss, damage or injury incurred whilst participating.

Please tick here if you wish to walk with a dog  ( must be on the lead )       [     ]  

  
Signature ______________________________________    Date ____________________________

 
[ ] DONATION :

       I am unable to take part, but would like to make a donation

             Amount: £ ________________________

You can enclose a cheque (made out to Bernadette Hoste ) in payment now, or donate online at  www.pralineswalk.weebly.com ( HOME page )

Please return this form by e-mail or to:
Praline’s Walk
c/o Bernadette Hoste
58, Stroud Road
London  SW19 8DG

The money raised by PRALINE’s WALK wil be divided 1/3  and 2/3  between  2 charities :    http://www.manytears.co.uk   &   www.voluntarioglobal.com.ar
Bernadette  020 89440015
e-mail : pralineswalk@gmail.com
www.pralineswalk.weebly.com