* 1. Your contact details:

* 2. Date of birth

* 3. What is your occupation?

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

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

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

* 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)

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