Type of virtual steps challenge * Distance goal * - -5k10k13.1 miles26.2 milesother Another distance * What is your fundraising target? To receive a medal and certificate on completion of your challenge, we ask for a minimum sponsorship pledge of £15 Is there a special reason for organising your event? (e.g. is it in memory of someone special?) How did you hear about Epilepsy Action? Terms and conditions: All funds raised will be given solely to Epilepsy Action and I agree to send donations within six weeks of completing my challenge. I understand that I am liable for any costs or risks that arise from my participation in this event. I understand that in order to receive a medal and certificate by post I must raise a minimum sponsorship pledge of £15. My certificate and medal will be posted to me once I have submitted confirmation of my completed challenge to Epilepsy Action. Agree to terms * I agree to the terms and conditions Over 16 I am 16 or over If you are under 16 we require your parent or guardian's consent for you to take part in a fundraising event in aid of Epilepsy Action. If you are under 16 please have your parent or guardian complete this form. Parent or guardian's name if you are under 16 Your details Title First name * Last name * Your email address Your phone number Your address Postcode * lookup or enter your address manually Organisation name Address * Address line 2 Address line 3 Town or city * Postcode Country We would like to keep you up-to-date about our work. Please tick how you would like to hear from us. * Email Text Phone None of these methods What would you like to hear about? * Ways Epilepsy Action can support me Ways I can help people affected by epilepsy Post - We would also like to write to you. Please tick if you'd prefer not to get post from us. Do not send me post Tick to opt out of postEpilepsy Action will never swap, share or sell your details. For more information, read our privacy policy.You can update your preferences at any time by contacting our supporter care team on 0113 210 8810 or emailing supportercare@epilepsy.org.ukEpilepsy Action privacy policy Leave this field blank
