Gelt Gladiator 2025 Payment Form

Payment form for Gelt Gladiator 2025

Name(Required)

First Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City County Postcode Country

Email(Required)

Emergency Contact Name(Required)

First Last

Emergency Contact Phone(Required)

Any medical conditions (Please state none if none)(Required)

You will receive a t shirt to wear on the day, what size would you like?(Required)

By ticking this box you understand that there is a minimum sponsorship target of £50(Required)

I agree

By ticking this box you agree that all fundraising monies raised will be handed into the hospice no later than two months after the event(Required)

I agree

Registration fee(Required)

Price:

Credit Card(Required)

Number