1. WALK TO REMEMBER REGISTRATION FORM <br />Name: _________________________________________<br />Address: ________________________________________<br />______________________________________________<br />Postcode: ________________________________________<br />Telephone: _______________________________________<br />Email: _________________________________________<br />Emergency Contact Name On Day: ________________________<br />Emergency Contact phone number: ________________________<br />I agree to raise a minimum sponsorship of £50. Yes No <br />Do you suffer from any health problems that might require medical attention<br /> during the walk?<br />Yes No If yes please state including any prescribed medication ______________________________________________<br />______________________________________________<br />I understand that if I am in doubt about my health or have a medical <br />condition that could be affected by exercise, I should obtain my doctor’s <br />approval before participation. I acknowledge that I participate at my own<br />risk and RBL cannot be held liable for any injury, loss or damage caused<br /> by or sustained as a result of my participation.<br />I understand this is a fundraising event and pledge to raise as much <br />sponsorship as possible. Please return completed Registration Form to:The Royal British Legion, Gore Road, Burnham SL1 8AE<br />THIS WALK IS ONLY OPEN TO THOSE OVER 18 YEARS OF AGE<br />Signed: _________________________________________<br />Date: __________________________________________<br />