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* 1. Your contact details:

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* 2. Date of birth

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* 3. What is your occupation?

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* 4. What is your motivation for representing the LA?

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* 5. Which challenge event would you like to register for? (specify date/location if required)

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* 6. What fundraising target will you be setting yourself?

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* 9. Would you like a t-shirt or vest? Please specify size (We can only offer a t-shirt/vest to fundraisers committing to raising over £100)

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* 10. Will you be setting up an online fundraising page?

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