ROSSENDALE & PENDLE MOUNTAIN RESCUE TEAM Entry Form
(one form required for each entrant)
Pendle 1000, 9am Saturday 11th June 2011, Barley Village, Pendle In aid of Rossendale & Pendle Mountain Rescue Team SURNAME
FORENAME
ADDRESS POST CODE EMAIL AGE (on day)
MALE/FEMALE
TELEPHONE
MOBILE
CONTACT NAME & NUMBER ON DAY IN CASE OF EMERGENCY (eg. NEXT OF KIN/FRIEND)
Entry Fee Enclosed £
(£15.00 per person, refundable if entrant is sponsored for £100 or more)
Confirmation of entry will only be sent out if SAE is enclosed with your application. Full details of registration times, start times etc will be emailed to you 2 weeks before the event. Please note: Under-18s must be accompanied by a named adult throughout.
If you are under 18 years of age you must have your Parent or Guardian sign the following: I ………………….………………………, agree that my child and I will abide by the agreement below and I further declare that my child has permission to take part in the PENDLE 1000 WALK and will be accompanied throughout the event by ………………………........................…………. who is over 18 years of age. Signed …………………………………………….. Date ……………… Relationship ………………...................... All entrants please complete and sign this agreement I ………………………………………......., hereby agree that Rossendale & Pendle Mountain Rescue Team and its appointed representatives shall in no way whatsoever be held liable for any loss, damage or bodily injury however sustained by the entrant during the course of the PENDLE 1000 WALK and the entrant hereby indemnifies Rossendale & Pendle Mountain Rescue Team and its appointed representatives against all claims, proceeding actions and costs in respect of such loss, damage or bodily injury herein before referred to. I have read and agree to abide by the published rules of this event (next page). Signed ……………………………………………………………………… Date ……………………............................ 4 6 C L E G G S T R E E T . H A S L I N G D E N . R O S S E N D A L E . L A N C A S H I R E . B B 4 5 LW
Regi stered Charity Number (58) 508209
Medical Information – Strictly Confidential Please include with this entry form, anything you think we should know, especially any drugs or medicine that you take regularly.
Details
Name * This section will be detached from the rest of the form and filed separately for the team medical practitioner’s information only
Please return this form to: Alwyn Hayes, Rossendale & Pendle MRT, 46 Clegg Street, Haslingden, Lancs BB4 5LW
ROSSENDALE & PENDLE MOUNTAIN RESCUE TEAM
OFFICIAL SPONSOR FORM The Rossendale & Pendle Mountain Rescue Team is a registered charity. Made up entirely of volunteers the team is an integral part of the regional and national search and rescue service. Called out through the 999 system, we cover an area of approximately 350 square miles across East Lancashire and parts of Greater Manchester. Through our links with both Lancashire and Greater Manchester Police, the Lancashire and Greater Manchester Ambulance Service and the Fire Service, many of our call outs involve missing person searches, assisting the ambulance service during severe weather conditions or rescuing casualties from steep ground situations. Operational team members are on call 24 hours a day, 365 days a year, come blizzard, rain or shine, to provide a professional search and rescue service – entirely free of charge to the general public and the statutory bodies with which we work.
search and rescue techniques, stretcher handling in extreme conditions, casualty handling, communications and advanced first aid in order to maintain high standards. As demand for our services grows so does the need for a new base, vehicles need to be housed and team members need better training facilities. We have outgrown our current base and plan to move into a purpose built facility. With your help we hope to do this in May 2012. Please complete the form below and return to the Alwyn Hayes, Rossendale & Pendle MRT, 46 Clegg Street, Haslingden, Rossendale, Lancashire BB4 5LW to register your intent to raise funds for us in this way. If you require further information about the team and its activities, please contact the Secretary. After the event, please return the completed sponsor forms with the monies raised to the Alwyn Hayes, Rossendale & Pendle MRT, 46 Clegg Street, Haslingden, Rossendale, Lancashire BB4 5LW.
Our knowledge of terrain and conditions, combined with specialist equipment, vehicles, training and casualty care is key to our service and team members undergo rigorous training in
Name Address
Post Code Telephone Event for which sponsorship will be collected PENDLE 1000
Date of Event 11TH JUNE
Please complete and sign this agreement I hereby agree that the Rossendale & Pendle Mountain Rescue Team shall in no way whatsoever be held liable for any loss, damage or bodily injury however sustained during the course of the event for which I am collecting sponsorship and that I hereby indemnify the Rossendale & Pendle Mountain Rescue Team against all claims, proceeding actions and costs in respect of such loss, damage or bodily injury herein before referred to. I also agree to pass ALL monies raised to the Rossendale & Pendle Mountain Rescue Team by 9th July 2011. Signed
Date
If you are under 16 years of age you must have a Parent or Guardian sign the following I ......................................................... agree that.........................................................and I will abide by the agreement above and I further declare that they have permission to take part in the specified event and will be accompanied throughout the event by ..................................................................., who is over 18 years of age, and that ALL monies raised by them through sponsorship for this event will be passed to the Rossendale & Pendle Mountain Rescue Team by 9th July 2011. Name Signed
Relationship
Date
4 6 C L E G G S T R E E T . H A S L I N G D E N . R O S S E N D A L E . L A N C A S H I R E . B B 4 5 LW
F O R P E N D L E 1 0 0 0 D E TA I L S
events@rpmrt.org.uk or 07957 758327
Regi stered Charity Number (58) 508209
Make cheques payable to ROSSENDALE & PENDLE MOUNTAIN RESCUE TEAM
AB1 23C
POST CODE
Remember you have a legal responsibility to ensure all sponsorship money is paid to the Rossendale & Pendle MRT. You may receive up to two reminder letters after the event if we have not received your sponsorship money within one month of the event.
TOTAL AMOUNT £ OF GIFT AID DONATIONS
DATE MONIES RECEIVED x22/78 = £
TOTAL
£xx.xx
AMOUNT PLEDGED
01.03.07
DATE GIVEN
√
GIFT AID?
TAX RECLAIMABLE
Tick box if you require a receipt
£xx.xx
AMOUNT GIVEN
Please note - Name, first line of address and postcode are mandatory for each individual entry, for us to be able to claim Gift Aid.
Make sure your sponsors fill in their full name and address details Check their post code is correct Tell them to tick the Gift Aid box if applicable Make sure all details are legible
1 Sample Gardens. Manchester
HOME ADDRESS
MOBILE
POST CODE
Tick here if you would like Rossendale & Pendle Mountain Rescue Team to claim tax on your sponsorship donation. This means that we get 28% more without it costing you a penny. Please bear in mind that you must pay an amount of income tax or capital gains tax equal to the tax that we claim on your sponsorship. Please make sure that we can read all your details as this supports our tax claim.
PLease Gift Aid it
SPONSORSHIP & GIFT AID DECLARATION FORM
And send to: Alwyn Hayes, Rossendale & Pendle MRT, 46 Clegg Street, Haslingden, Rossendale, Lancashire BB4 5LW
Gift Aid it...
Anne X Sample
FULL NAME
TELEPHONE
ADDRESS
NAME OF WALKER
EVENT
ROSSENDALE & PENDLE MOUNTAIN RESCUE TEAM