MPD-Support - Support - Walk 2009

2009 Walk for a Cure

Places for the Walk are limited. If after registering you find that you will be unable to attend, please contact fundraising@mpd-support.co.uk at least one week prior to the event so that we may release your place to other fundraisers.
First Name:
Last name:
Address:
Postcode:
Landline number:
Mobile number:
E-mail address:
Age (if under 17):
The cost of registration is £10 for adults and £5 for children under age 12 and under. The registration fee enables us to cover park fees and insurance. We will also provide each walker with an exclusive MPD Support baseball cap and badge and a bottle of water! Payment You may pay by post or pay on the day.
Number of people who will be walking with you (up to 5):
	Adults Children age 12 and under

Please select a payment option:	Pay in advance by post Pay on the day
(If you are paying by post, please send your cheque to Claire Harrison, MPD CNS Haematology Dept, 4th Floor, North Wing, St Thomas’ Hospital, Lambeth Palace Road, London, SE17 EH)