PHYLLIS TUCKWELL HOSPICE

SPONSORSHIP FORM - FLORA LONDON MARATHON 2003

To sponsor a person or a whole team to run in the London Marathon on Sunday, 13 April 2003
please print and complete this form and send to:
Fundraising Dept, Phyllis Tuckwell Hospice, Ref. M4611, Waverley Lane, FARNHAM, Surrey GU9 8BL
Or fax it to 01252 729414
You may also call Claire Walker on 01252 729433 with your credit card details if preferred
 

I wish to pay by  (please tick as appropriate)

Cheque

Postal Order

Mastercard

Visa

Switch

(please make cheques payable to Phyllis Tuckwell Hospice)
Card No:
Expiry Date: Switch Issue No or Start Date:

I would like to sponsor the following people:

Amount per person ............................

..................................................................................................................

..................................................................................................................

I would like to sponsor the whole team:

Amount  ............................

..................................................................................................................

 
COMPANY  
FIRST NAME .............................................................................................
SURNAME .............................................................................................
TITLE .............................................................................................
ADDRESS .............................................................................................
  .............................................................................................
POSTCODE .............................................................................................
DAYTIME TELEPHONE NO .............................................................................................
E-MAIL .............................................................................................
SIGNATURE .............................................................................................
 

back