Great North Run application form

Thank you very much for your interest in running in the Great North Run for Bliss.

Please complete the form below in as much detail as possible to apply for your place in Team Bliss.

Please also apply for a ballot place as well as applying to run for Bliss. That way, when results are announced, you may be lucky enough to get a ballot place. In that case, we'll be able to refund your registration fee (or allocate it to your fundraising), you can still run for Team Bliss and your charity place will go to someone on our waiting list.

We will contact you to let you know if you have been successful in your application. If you are then we will ask you to pay a registration fee of £35.

Your details

Title Please selectMrMrsMsMissMx

First name

Last name

Address line 1

Address line 2

Address line 3

Town or City

Postcode

Date of birth

Email address

Phone number

Type of phone number Please selectMobileHomeWork

Running for Bliss

How did you hear about Bliss' places for this event? Please selectGreat Run's websiteBliss websiteBliss Facebook pageWord of mouthBliss events calendar (leaflet)Other

If other please give details

Please tell us your connection to our work: I am a parent or guardian of a baby born premature or sickI am a friend or family member of someone who has had a baby born premature or sickI am a bereaved parentI am a neonatal healthcare professionalI am a healthcare professional, but I don’t work directly in neonatal care (such as a GP or midwife)I was born premature or sickOther (please specify)

Please tell us why you would like to run for Bliss

Are you raising funds in memory of a loved one?

If you would like to find out more about setting up a tribute fund please contact events@bliss.org.uk for further information.

Bliss requires you to agree to a sponsorship pledge of £400 for your Great North Run place.

How would you hope to raise this amount?

Do you think you could raise more than £400? Yes No

If so, how much?

Does your employer operate a matched giving scheme? Please selectYesNoI don't know but I will enquire

If yes, what is the name of your company?

Occupation

Have you taken part in a running/sporting event before?

Have you supported Bliss in the past? Please selectYesNo

If so, thank you! How did you support us?

Would you like a male or female running vest? Please selectMaleFemale

What is your running vest size? Please selectSmallMediumLargeExtra large

Terms and conditions

• By agreeing to these terms and conditions you are pledging to raise £400 for Bliss (excluding Gift Aid) by 8 October 2023.
• I will endeavour to raise the first £100 of my fundraising target by 3 July 2023. If I am unable to demonstrate by this date a commitment to meeting my fundraising target I understand that may result in me being unable to take part in the event.
• Once your place has been confirmed we require a registration fee payment of £35 for your place. If you drop out for any reason your deposit is non-refundable and it cannot be rolled over to next year’s Great North Run or another event.
• Bliss does not take responsibility for any health issues during your training for the marathon or any incidents that occur on race day. If you have any health concerns prior to, or during, your training please consult with your doctor.
• Bliss reserves the right to refuse an application at its absolute discretion.
• You must be 18 years or over on the day of the race.
• If you are unable to participate in the event for any reason, all donated monies collected in support of Bliss must be forwarded to the charity or returned to the individual sponsors. Monies already received by the charity will not be refunded.
• You must contact Bliss immediately if you think you are going to be unable to participate.
• When Bliss establishes contact described as "urgent", runners must respond via email/telephone/in writing as quickly as possible.
• By signing up to the Great North Run you are consenting to Bliss using any images of you in their promotional materials. Please contact us in advance of the run if you are unhappy with this arrangement.
• If you fail to return your timing chip at the end of the race, any costs incurred by Bliss will automatically be transferred to you.

I have read and understood the terms and conditions above and would like to apply for a charity place to run for Bliss. I understand that if accepted for a Bliss charity place I am undertaking a pledge to raise £400 (excluding Gift Aid) for Bliss by 8 October 2023.

Name

Date

Let's keep in touch

Your support helps the most vulnerable babies in the UK. We’d love to keep you updated with news about our work and ways you can get involved with Bliss. Are you happy to be contacted by:

Email Please selectYesNo

Post Please selectYesNo

Telephone Please selectYesNo

Text message Please selectYesNo

Your privacy

We (Bliss and Bliss Scotland) promise we will use the personal data you have provided to communicate in the way(s) you have agreed to.

We will not pass on your details on to any third party organisation for their marketing purposes.

Find out how we look after your personal details in our Supporter Promise

You can opt out of all communications from Bliss at any time by calling the Fundraising Operations Team on 020 7378 5740 or emailing fundraisingoperations@bliss.org.uk