Five Valleys Walk 2017 book now Book your place early for the Five Valleys Walk 2017 on Sunday 24 September 2017 Five Valleys Walk 2017 Personal details TitlePlease select... Mr Mrs Miss First Name Last Name Date of birth Organisation name If applicable Email Phone Whichever is your preferred number Street Address Town or City Postcode About the event Which checkpoint will you be starting from?Please select... Nailsworth Minchinhampton Brimscombe Lypiatt Slad Pitchcombe Standish Wood Stroud Cricket Club How many dogs are you bringing? Please select... 0 1 2 3 4 5 6 7 8 9If applicable In the event of an emergency please contact: Name Relationship to youPlease select... Husband Wife Partner Mother Father Daughter Son Sister Brother Guardian Other family member Friend Nephew Niece Uncle Aunt Grandparent Contact number How did you hear about this event?Please select... Leaflet Email Facebook Twitter LinkedIn Internet search Other website Meningitis Now website E-news Previous participant Radio Newspaper coverage TV Friend/family Meningitis Now staff Volunteer Other If other please state Your meningitis experiencePlease select... Personal experience Family experience Friend/Colleague experience Nursery experience Pupil/Student experience Employee experience Professional experience No experience Please tick here of you are happy for us to contact you about your experienceYes Ticket requirements Adult ticket (£10) Please select... 1 2 3 4 5 6 7 8 9 1016 upwards Child ticket (£5) Please select... 1 2 3 4 5 6 7 8 9 10Under 5s free Group Ticket (£25) Please select... 1 2 3 4 5 6 7 8 9 10Up to 4 people Gift aid declaration and donations Donation amount (£xx.xx) Giftaid it Thanks to the Government’s Gift Aid scheme, Meningitis Now can reclaim 25p on every £1 its supporters donate. If you are a UK taxpayer, you can make your donations worth 25% more to us at no extra cost to you.I confirm that I am a UK Income or Capital Gains taxpayer. I have read this statement and want. Meningitis Now to reclaim tax on the donation detailed above, given on the date shown and any donations I make in the future or have made in the past 4 years. I understand that if I pay less Income. Tax or Capital Gains tax in the current tax year than the amount of Gift Aid claimed on all of my donations, it is my responsibility to pay any difference. I understand Meningitis Now will reclaim 25p of tax on every £1 that I have given. I am not a UK taxpayer Today's date Select the way(s) you would like us to contact you We would like to contact you by post, phone, SMS and email to update you about our work and activities. If you are happy to receive this information from us, please tick the relevant boxes:I have selected how I would like to be contacted Post Phone SMS Email No contact By submitting you agree to the Terms and Conditions belowI agree Terms and conditions Click 'submit' to be redirected to the payment page, please have your credit card, debit card, or PayPal login ready Need assistance with this form?