Virtual London Marathon 2022 Application Form

Your contact details

Preferred Title*

First Name*

Surname*

Email*

Phone number (Mobile or Home)*

Street Address 1*

House/Flat Number and Street Name

Street Address 2*

Area e.g. Southmead, Lockleaze, Southville

Town/City*

Postcode*

Running for Southmead Hospital

Why do you want to run and raise money for Southmead Hospital?*

For example, do you have personal experience as a patient or has a loved one received care here? Tell us why you're passionate about Southmead Hospital!

What’s the longest distance you’ve run?

Please share a little information about your running ability.

Please confirm that you're committed to raise a minimum of £500.*

Yes
No

Please provide details of how you plan to raise your sponsorship?

Where do you work? If your employer has a ‘matched funding’ scheme for your fundraising, please provide details:

Are you happy for your photo and story to be used online and in print by Southmead Hospital Charity and North Bristol NHS Trust?*

We'll work with you to ensure you're happy with anything that we publish.

Yes
No

How did you find out about our Virtual London Marathon 2022 places?

Contacting you

Southmead Hospital Charity email marketing

We'd like to email you about other ways you can help support the staff and patients at your local hospitals. Please tick the below box to hear from us via email.

Yes, I’d like to hear from you via email

Southmead Hospital Charity marketing permissions

We would like to contact you in the future about the impact of your generous support. If you would prefer not to hear from us in the future, you can opt-out using the tick-boxes below.

No, I don't want to be contacted by post
No, I don't want to be contacted over the phone

View our privacy policy here.

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Apply to run the Virtual London Marathon for Southmead Hospital

Your contact details

Running for Southmead Hospital

Contacting you

Thank you for your support – it makes a huge difference to our patients, their families and our staff.