London Marathon 2012
Oxfam charity place application form

Your details

Title: *
Select... Mr Mrs Ms Miss Doctor Professor Reverend or

First name: *

Last name: *

Age: * (Participants must be aged 18 years or over at the time of the event.)

Postcode: *(For UK addresses only)

Address:
Address Lookup

Address Line 1: *

Address Line 2:

Town: *

County: *

Country:
Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (DRC) Congo, Republic of Cook Islands Costa Rica Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakstan Kenya Kiribati Kosovo Kuwait Kyrgystan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Minor Outlying Islands (U.S.) Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia South Korea Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican Venezuela Viet Nam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe

Please provide us with the best telephone number(s) on which to reach you. At least one phone number must be provided. *

Home phone:

Mobile phone:

It is most cost effective for Oxfam to advise you by email whether or not you have been successful in gaining one of Oxfam's charity places. Therefore please do provide us with your email address. By providing your email address you are also agreeing to receive communications about our projects and activities. You can unsubscribe easily at any time, and we will not share your details with any other organisation.

Email:

Occupation:

Employer:

Does your employer run a matched giving scheme? Please give details of up to how much they will match:

Fundraising pledge

I would like to apply to run the Virgin London Marathon 2012 for Oxfam GB. If offered a place, I am aware that I will need to pay a £100 entry fee and complete a pledge confirmation, pledging to raise a minimum of £2000 (excluding Gift Aid).

Please tell us your fundraising plans: *
Please give details, including how you will reach your pledge.

I pledge to raise: £ * (minimum £2000)

Is there anything about your run that might make a good story for the media?

Do you already run regularly? *

Yes No

Have you completed a full marathon before? *

Yes No

What is your predicted time in the London Marathon 2012? *

(eg: 4 hours 30 minutes)

If you are successful in securing one of our 2012 London Marathon places, we will provide you with a running vest or t-shirt. Please select which you would like to receive. *
Running vest Running T-shirt Please select

Please specify your running vest/T-shirt size: *
Female extra-small Female small Female medium Female large Male small Male medium Male large Male X-large Male XX-large Please select

Did you enter the London Marathon Ballot this year?*

Yes No

Please indicate which of the following first prompted you to get in touch with us? *

Please select Oxfam email Listing or advert on the London Marathon website Google or another search engine Oxfam website Oxfam shop Realbuzz forum Facebook Seeing Oxfam at an event I have run for Oxfam before Existing Oxfam supporter I heard from a friend or family Other (please specify below)

If you selected 'other' please specify here:

Do you have special requirements we need to know about? If yes, please specify:

Terms and conditions

I confirm that I have read and agree to Oxfam's Virgin London Marathon guaranteed charity place terms and conditions [PDF, 30 KB].*