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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. Are you entering as an individual or team?

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* 6. If you are part of a team please indicate the names of the individuals in your team below:

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* 7. If you are entering as an individual please indicate which part of the tri you want to take part in:

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

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

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