Title Please select: Mr Mrs Miss Ms Dr First Name* Surname* Address 1* Address 2 Address 3 Town* County Please select: Aberdeenshire Anglesey Angus Bedfordshire Berkshire Bristol Buckinghamshire Cambridgeshire Carmarthenshire Ceredigion Cheshire Clackmannanshire Conwy Cornwall County Antrim County Armagh County Down County Durham County Fermanagh County Londonderry County Tyrone Cumbria Denbighshire Derbyshire Devon Dorset Dumfries and Galloway Dundee East Lothian East Riding of Yorkshire East Sussex Essex Falkirk Fife Flintshire Gloucestershire Greater London Greater Manchester Gwent Gwynedd Hampshire Herefordshire Hertfordshire Highlands Isle of Wight Kent Lancashire Leicestershire Lincolnshire Lothian Merseyside Mid Glamorgan Monmouthshire Moray Norfolk North Yorkshire Northamptonshire Northumberland Nottinghamshire Oxfordshire Pembrokeshire Perth and Kinross Powys Rutland Scottish Borders Shropshire Somerset South Glamorgan South Yorkshire Staffordshire Stirlingshire Strathclyde Suffolk Surrey Tyne and Wear Warwickshire West Glamorgan West Lothian West Midlands West Sussex West Yorkshire Western Isles Wiltshire Worcestershire Wrexham Other Other - Please give details Post Code* Country Please select: England Northern Ireland Scotland Wales Other Other - Please give details Is this your home address? Please select: Yes No
Email Address* Daytime Contact* Evening Contact* Mobile Date of Birth (if under 18)
About your event
Type of event* Please select: Running Walking Hiking/Trek Cycling Skydive Abseil Zip Slide Coffee Morning Dress Down Day Forget Me Not Walk Why 17? Event Always Loved Never Forgotten Fund Other Other - Please give details Other team members? Have you raised funds for us before? What are your reasons for raising money for Sands? Where did you hear about Sands? Please select: Family Friend Colleague Media Facebook Twitter Website Other If Other, please provide details Name of Event Date of Event Do you have your own place? Please select: Yes No
I require a Sands place for Please select: BUPA Great Manchester Run BUPA Great North Run BUPA Great Birmingham Run BUPA Great South Run British London 10k Run How much do you think you will be able to raise?
Do you have an online giving page i.e. JustGiving?* Please select: JustGiving VirginMoneyGiving DoItForCharity(DiFC) BeMyCharity MuchLoved Other
Other - Please give details
Fundraising Page Address
If no, will you be creating one? Please select: Yes I will be I'm unsure No I won't be
Please provide us with brief details of your planned event Are there any other charities benefitting from this event? Please select: Yes No
If yes, which one(s)
** A donation towards the cost of producing these t-shirts/running vests is not essential but would be appreciated especially if you require more than one. Suggested amount £4.50 each.
Sands T-Shirt Please select: Small/Med Large X Large XX Large XXX Large Sands Running Vest Please select: Small Medium Large X Large XX Large
Once we have received your completed form we will send you your official Authorisation to Fundraise in aid of Sands and Fundraising Pack which amongst other things includes all the elements you need to start your fundraising off, including sponsor forms, blank posters, awareness poster, money return form.
We also have balloons, stickers and collection tins and buckets available. Please get in touch if these would be helpful.
** If you require a hand held collection box(es) you are required to complete a seperate form and this will be sent seperately to you.
** Collection Tin(s) Are there any other ways we might be able to help you?
On occassions supporters
may choose to designate part of their fundraising donation to a specific appeal, project or Sands group.
Please be aware that due to the accounting systems in place we are unable to restrict funds received retrospectively, and restrictions can only be applied from the date any instruction is received in writing.
If you would you like a local Sands group to benefit from the funds you raise, please indicate here: Please select: Yes No
If yes, please provide the group name Please select: Aberdeen Sands Ashington Sands Ayrshire Sands Bath Sands Bedfordshire Sands Belfast Sands Berkshire Sands Birmingham Sands Blackpool and Preston Sands Boston Sands Bradford Sands Brighton & Hove Sands Bristol Sands Burton & District Sands Cambridge Sands Cardiff and Newport Sands Carmarthenshire & Pembroke Sands Chelmsford Sands Cheshire East Sands Chester Sands Chesterfield Sands Chichester Sands Cornwall Sands (Contact) Coventry & District Sands Derby Sands Deveron Sands Dumfries and Galloway Sands Durham & Wearside Sands East Cumbria Sands East Herts Sands East Lancashire Sands Essex Sands (Contact) Exeter Sands Farnborough Sands Fife Sands Formby & Southport Sands Forth Valley Sands Fraserburgh & Peterhead Sands Glan Clwyd Sands Glasgow Sands Gloucestershire Sands Guernsey Sands Gwynedd Sands Halton & Widnes Sands Havering Sands Hereford & Worcester Sands Horsham & District Sands Huddersfield Sands Hull and East Yorkshire Sands Huntingdon Sands Inverness Sands Isle Of Man Sands (Contact) Isle of Wight Sands Jersey Sands Kent Sands Kidderminster Sands Kings Lynn Sands Leeds Sands Leicestershire Sands Lincoln Sands Liverpool Sands Lomond Sands Manchester Sands Mid Devon Sands Milton Keynes Sands Moray Sands Newcastle Sands Norfolk Sands North & East London Sands North Herts Sands North Manchester Sands Northamptonshire Sands Northern Ireland Sands - Antrim Sands Northern Ireland Sands - Cookstown Sands Northern Ireland Sands - Derry Sands Northern Ireland Sands - Enniskillen Sands Northern Ireland Sands - Newry Sands Northern Ireland Sands - Portadown Sands Nottingham Sands Oldham Sands Oxfordshire Sands Peterborough Sands Portsmouth Sands Powys Sands Salford Sands Sands Network - East Sands Network - North Sands Network - Northern Ireland Sands Network - Scotland Sands Network - South Sands Network - Wales Sands Network - West Scunthorpe Sands Shropshire Sands Solihull Sands South Cumbria Sands (Contact) South Devon Sands South East London Sands South West London Sands Southampton Sands Staffordshire Sands Stockport Sands Surrey Sands Swansea Sands Swindon Sands Tamworth Sands Taunton Sands Tayside Sands Tunbridge Wells Sands Tyne & Wear Sands (Contact) Valley Sands Waltham Forest and Enfield Sands West Hertfordshire & Buckinghamshire Sands West London Sands Wigan & St Helens Sands Wirral Sands Wolverhampton Sands Wrexham Sands Yeovil Sands York Sands
% split to pass to the group at the end of your fundraising Please select: 5% 10% 17% 25% 50% 75% Other
Other - Please give details
In the unlikely event that these funds cannot be reasonably, efficiently and fully spent where specified, they will be used on a similar project, appeal or where the need is felt to be the greatest.
We take seriously our responsibilities in the public interest to ensure the best and most efficient use of the donations entrusted to us
*** By submitting this form you confirm that you have read 'Keep it Legal, Keep it Safe' and agree by Sands 'Terms and Conditions' and the points listed below.
1. I understand that Sands will, in no way, be liable for any claim which may arise from this event. I acknowledge that the individual/organisation is undertaking this activity entirely of their own risk and that Sands (Stillbirth & Neonatal Death Society), shall not be liable for any injury or loss that might occur as a result of this event.
2. I agree to pay all proceeds of the event to Sands as quickly as possible after the event.
Your support makes our vital work possible. We'd like to keep in touch with you to tell you more. Please tick the box below if you are happy for us to contact you again in the future?
* Please keep in touch