* 1. Your Name:

* 2. Your address:

* 3. Your contact number:

* 4. Your email address:

* 5. Your occupation:

* 6. Your date of birth:

* 7. Have you committed to doing any fundraising for a charity before? If yes please detail below.

* 8. How much running are you currently doing?

* 9. Have you previously run a Marathon? If yes please detail below including times.

* 10. What is your connection to the Limbless Association? If none where did you hear about us?

* 11. Why do you want to run for the LA in the London Marathon?

* 12. Our runners have been given a target of £2,500 for their fundraising. If a place was to come available by 1st January do you think that target is realistic for you? If not please advise how much fundraising you believe you could commit to.

* 13. If successful are you happy for us to promote your training and fundraising?

* 14. Would you like to be added to our email mailing list to be kept up to date with the charity, our services, fundraising news and opportunities?

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