Starlight Walk 2012

Starlight Walk Reg Page Picture

East Lancashire Hospice invites you to join them for a girl’s night out with a difference on Saturday 30 June 2012.

Put on your walking shoes and help make a difference, join our 8 mile ladies only Starlight sponsored walk.

A fully marshalled walk starts at 10pm (registration from 8.30pm) and ends at the Soccerdome, Guide. The streets of Blackburn will see a sea of women and girls of all ages and fitness levels join together to raise money for East Lancashire Hospice to provide a specialist supportive and end of life care to the people of Blackburn, Darwen, Hyndburn and the Ribble Valley.

The hospice needs to raise 3 million each year and relies heavily on donations and fundraising events such as this to continue to offer a special way of caring.

We guarantee you a night to remember and whether you are walking in memory of someone dear or to ensure that our special way of caring is there for the future generations, you can rest assured that the sponsorship money raised will make a positive impact on the people in your area.

To enter please complete the form below and reserve your place for making a difference.

Personal information

Title:
First name:
Last name:
Home address:

Town/city:
Postcode:
Telephone No.:
Donor number: (if known)
Age (if under 16):
	You need to be 10 years or older to take part in the Starlight Walk. If you are under 16 years of age please ensure your parent or guardian sign the form below. Also under 16 you need to be accompanied by an adult to take part.
I am the parent/guardian of:	and have given by consent for them to take part in the walk.
Parent/guardian name:
Date:
Contact address:
Telephone No.:
E-mail:
How did you hear about the walk:
T-Shirts:	Child Small (8-10) Medium (12-14) Large (16) X-Large (18+)
Additional information
Please advice on any dietary requirements:
Please advice on any medical conditions:
If you know of anyone who may be willing to volunteer on the night, please give us their contact details
Name:
Telephone No.:
E-mail:

Payment details

Sponsored run for East Lancashire Hospice. Entry fee £10

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Starlight Walk 2012

Personal information

Additional information

Payment details