MNDA East Kent - RubyWalk 2019 to D'Feet MND Registration Form

Please complete the form below to register for the walk, please supply an emergency contact and phone number.
Please enter a medical note if there is something we should know in case of emergency.
Please ensure all fields marked with a blue background are completed. If you cannot complete any field please enter None.

Privacy Statement

Please note that by completing this form, you are giving us permission to store your details for the purpose of Walk to D'Feet MND. We will use this information solely for contacting you about this event and future Walk to D'Feet events.

First Name * :

Last Name * :



Telephone Home:

Telephone Work:

Telephone Mobile * :

Email Address * :

Emergency Name * :

Emergency phone * :

Walk Length * :

T Shirt Size * :

Medical note:

From time to time we may wish to advise you of other MNDA events in East Kent. If you wish to receive such information please select Yes Please, otherwise please select No Thankyou.

Select Option * :