* 1. Your contact details:

* 2. Date of birth

* 3. What is your occupation?

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

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

* 8. 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)

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

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