Application Form Vetting Questions

Thank you for registering your interest in running for St John Ambulance in the Great North Run 2012.

Please complete all the details in the form below and answer the questions as thoroughly as you can. This application form is the sole basis in which we make our decision as to whether you are successful in gaining a place.

This is an initial application form that does not require you to make the payment of the £30 registration fee. If accepted on to the St John Ambulance team we will contact you in the next few days to discuss your application.

If accepted the registration fee of £30 (incl. VAT) must be paid within seven working days of a place confirmation. We also require all runners to have raised £100 by Monday 3rd September 2012 and full sponsorship fee by 29th October 2012.

If you have any further questions about the application process or the associated terms and conditions, please contact the Events Team at events@nhq.sja.org.uk or call 020 7324 4173.

Any information submitted will be confidential.

Terms and Conditions

St John Ambulance requires all Great North runners to agree to our Terms and Conditions. Any information given will be treated with confidence. Please read these terms and conditions carefully:

I pledge to raise a minimum of £350 for St John Ambulance excluding Gift Aid
I am aware that I am required to submit at least £100 of my sponsorship by Monday 3rd September 2012 and full sponsorship fee by 29th October 2012 to St John Ambulance NHQ
I will pay my non–refundable £30 registration fee to take part in this event
I agree to take part in the Great North Run 2012 at my own risk. St John Ambulance will not be responsible for any loss, damage, illness, injury or death caused or arising out of my involvement with this event
I am not aware of any medical condition or other reason why I should not participate
I will be over 18 years of age on the day of the event
If I do not take part due to illness or injury I understand that I do not have to raise the minimum sponsorship target, but if I can donate money to St John Ambulance, I will.

Data protection statement

Your data will be handled in accordance with the Data Protection Act 1998 and will be used by us in connection with your registration and to keep you informed about our activities, events and services. We will use your information to send you newsletters, information and updates for other fundraising purposes. We may send offers and information by mail, email and telephone. We will not share your information with any third party organisations except where we are required to do so by law or where we have a contract in place for the lawful processing of data. You have a right under the Data Protection Act 1998 to obtain information from us. If you have any queries concerning this right or no longer wish to receive information about our other activities, please contact our Data Protection Officer at St Johns Gate, London EC1M 4DA.

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Address

St John Ambulance, 27 St John's Lane, London EC1M 4BU

Company details

Registered charity no. 1077265/1. A company registered in England no. 3866129.
Registered office: St John's Gate, Clerkenwell, London EC1M 4DA


Name*
Address*
Postcode*
Email*
Date of birth*
Mobile number*
Home phone
Work phone
Occupation
Employer
Which running top would you like?*	Vest T-shirt
Please select your size*
How did you hear about St John Ambulance’s places in this event?*
Why do you want to run the Great North Run?
Predicted time (hours and minutes)?*
Have you applied for your own place directly through the Great North Run?	Yes No
Are you aware of any medical condition(s) or other reason not to participate?*	Yes No
Explain
Why do you want to raise money for St John Ambulance?
We ask all runners to raise a minimum of £350 sponsorship, do you confidently think you could raise this?*	Yes No
How do you plan to reach your sponsorship target? Give details of any ideas and activities
Do your company offer matched giving (e.g. your company matches all or some of what you raise)	Yes No
Is this your first charity running event?	Yes No
If no, please give details about your past charity sponsorship events – when, who the event was for and how much you raised?
Have you, or a friend or relative, ever been treated by a first aider, treated someone yourself, or been involved with St John Ambulance in any other way (please give details)	Yes No
Details
If you already support St John Ambulance (e.g. monthly donations, one-off donations, volunteering etc) please tell us how?
Would you be willing for your details to be shared with the PR team to help raise awareness of our work? We won’t release your details to the media without contacting you first of all.	Yes No
St John Ambulance would like to keep you informed about our offers, activities, events and services (see data protection statement below)
Please keep me informed	Yes
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