BUPA Great Edinburgh Run – Sunday 7th October 2012 OCD-UK Application Form Through participation in fundraising events like the Great Edinburgh Run, OCD-UK are able to continue to provide advice, support and encouragement to children and adults affected by Obsessive-Compulsive Disorder (OCD). Each year the Great Edinburgh Run becomes more and popular with race reaching capacity long before race day, but OCD-UK are lucky enough to have secured 5 guaranteed places for 2012. Please complete this application form and email it back to OCD-UK at office@ocduk.org to be considered for entry into the 2012 Great Edinburgh Run. Places are usually allocated quickly long before race day, so please send your application back to us ASAP. If you agree to run and fundraise in the region of at least £250 for OCD-UK we will pay your race fee, provide you with a training guide, fundraising tips and an OCD-UK running vest, and an orange OCD-UK t-shirt for any family/friends so you can spot them in the crowd. I very much look forward to running the Great Edinburgh Run with you in 2012. Ashley Fulwood Chief Executive of OCD-UK Personal Details Title (Mrs/Ms/Miss) First Name Surname Preferred Name if different from above Date of Birth Age on day of race Home Address (inc post code) Home Telephone Number Mobile Telephone Number Email Address Do you have a special reason for running for us? Great Edinburgh Run - 2012 Application Form Page 1 of 4 OCD-UK Running Vest or T-Shirts In addition to the serious nature of the fundraising from this event, we also believe it is an ideal opportunity to raise awareness about Obsessive-Compulsive Disorder with other runners, and amongst the thousands of people lining the streets cheering. So we ask all our runners to wear an OCD-UK running vest (can be worn over a t-shirt). We can also arrange to have your name printed on the vest if you would like that. You will find the crowd cheer you on by name if you struggle and need a little support it can make the world of difference. Please Indicate Your Required Running Vest Size? Men’s Cut: S (38”) [ ] M (40”) [ ] L (42”) [ ] XL (44”) [ ] XXL (46”) [ ] Ladies Cut: XS (32”) [ ] S (34”) [ ] M (36”) [ ] L (38”) [ ] XL (40”) [ ] (place X in required size) Please enter your desired name to be printed on the vest, i.e. ‘Ash’ rather than ‘Ashley’, leave blank if you prefer not to have your name printed on the running shirt. ________________________________________ Would you like any OCD-UK t-shirts for family/friends who will be there on race day to cheer you on? Unisex Orange T-shirt: S [ ] M [ ] L [ ] XL [ ] (place number required against each size) Children’s Orange T-Shirt: XS 22-24” [ ] S 26-28” [ ] M 30” [ ] L 32-34” [ ] XL 34-36” [ ] Baseball Caps ________ (number required for yourself/supporters) Fundraising Target We ask our runners to pledge to raise a minimum of £250 in sponsorship for OCD-UK by the end of June 2011 (excluding Gift Aid). Don’t worry, if you are not sure you will be able to achieve this, just let us know how much you think you can raise, and we will try and help you. How much do you anticipate being able to raise for OCD-UK? How do you anticipate raising this amount? Do you believe you will be able to achieve your fundraising target comfortably? What, if any, support would like from OCD-UK to help you achieve your target? Running for OCD-UK Upon completion of this event, would you be interested in running for OCD-UK again in the future, perhaps in 2013 in another 10K, half marathon or a full marathon? Are you happy for us to email you when other running events come up? Great Edinburgh Run - 2012 Application Form Page 2 of 4 Great Edinburgh Run – 2012 OCD-UK Terms and Conditions of Entry OCD-UK reserves at its absolute discretion the right to refuse an application. You agree to pay a registration fee, which will be refunded back to you, by cheque, once you reach the minimum sponsorship level of £250. You understand that completion of this application form does not guarantee a place in the race and is subject to written acceptance by OCD-UK and availability of places. By accepting one of our guaranteed places you pledge to raise a minimum of £250 for OCD-UK (excluding gift aid). You agree to wear an OCD-UK branded running vest or T-Shirt during the race. Allow OCD-UK to use any race photographs of you for website or other promotional publications for 18 months after the 2012 race. If you are unable to participate in the run for any reason all donated monies collected in support of OCD-UK must be forwarded to the charity immediately if your sponsors agree or returned to the individual sponsors. Monies already received by the charity can not be refunded. Cheques should be made payable to ‘OCD-UK’. You understand that OCD-UK and its employees or volunteers cannot be responsible for injury or death, accidents or loss or damage to personal effects, howsoever arising. You are entering the run of your own volition and therefore confirm that your general state of health and fitness is good and that you understand that any injury sustained by you during the race or whilst training is your own responsibility and not the responsibility of OCD-UK. In return OCD-UK will offer you the following support to support your challenge. Fundraising tips and advice Help setting up your online Virgin Money or Just Giving webpage 10K training booklet (PDF Download) Advice and tips from previous 10K runners OCD-UK running vest, made from breathable material Exchange support suggestions with other OCD-UK runners. Access to a 'Running for OCD-UK' Facebook group Great Edinburgh Run - 2012 Application Form Page 3 of 4 DECLARATION By returning this application form back to OCD-UK we will assume this is permission for us to enter you in the Great Edinburgh Run 2012 and that you agree to all terms and conditions above. That you are confirming that your general state of health is good and that any injury sustained during the race or training is your responsibility and not the responsibility of OCD-UK. And that you pledge to raise the minimum sponsorship of £250 (before gift aid) by the end of June 2012 and to pay the registration fee of £25 within one week of this application being sent to OCD-UK to show your commitment to the event and to OCD-UK. If you would like to run for OCD-UK but are unable to pay the registration fee, please contact us and we will do all we can to help you. You accept that this registration fee will only be returned to you once you reach the minimum fundraising target of £250, and can not be returned to you for any other reason. Please accept this application as my confirmation I agree to your terms and wish to participate in the Great Edinburgh Run in 2012 for OCD-UK – Please type your name below if emailing this form back. Name: Date: Please return the completed and signed form to: OCD-UK, PO Box 8955, Nottingham NG10 9AU and / or email a copy to office@ocduk.org If you do not have access to a scanner and can not scan the signed form, we will accept an unsigned form being emailed back to us, with the following wording on your email ‘Please accept this application as my confirmation I agree to your terms and wish to participate in the Great Edinburgh Run 2012 for OCD-UK’, we will then send you a copy of the form to sign and post back to us. What Happens Next? Once we receive a signed application form, we will send you an email confirming if we have any places remaining and if we can offer you a place to run for OCD-UK in the 2012 Great Edinburgh Run. If we offer you a place, we require you to pay the registration fee within two weeks. We will then submit your entry to the Great Edinburgh Run system who will email you to confirm your entry details via an online ‘token’. We will email you to let you know that your application has been submitted and send you training and fundraising forms. We will post you sponsorship forms and OCD leaflets to pass to sponsors. Your running vest will be sent out about 2-4 weeks prior to your run. GOOD LUCK and THANK YOU for your interest in running for OCD-UK Great Edinburgh Run - 2012 Application Form Page 4 of 4