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* 1. Full Name 

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* 2. Phone Number

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* 3. Email Address

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* 4. Please confirm you have read the below:

You confirm you are over the age of 18 or over the age of 14 with parental/guardian permission?


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* 5. Please tell us why you would like to take part and fundraise for Legacy

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* 6. Would you like to sign up to our mailing list to receive up to date news from Legacy ?

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