Stafford Rotary Club

 Chartered in 1924  District 1210  www.staffordrotaryclub.org.uk      updated 8th April  2022

Stafford Rotary Club
www.staffordrotaryclub.org.uk


Welcome to  the website of the Stafford Rotary Club, United Kingdom

home

SLEEP OUT 22

newsletter

programme

contacts

speakers

charities

club officers

Registration form

pony ride

rotary wheels

what is Rotary

Schools

Sleep Out 2019

Health Awareness


Food bank

sports

gallery

membership

easyfundraising

Title Mr Mrs, Miss, M/s


First Name


Surname


Address


Post Code


Phone Number


Email address


Confirm email address


Date of Birth ( must be 18 or over)


Medical Information


Any medical information (please declare for your own safety


Any medication required for this condition, if so, please ensure that you carry them with you.


Any dietary requirements / allergies etc


Any disabilities or access requirements


Emergency Contact

Name

Next of kin, family member or friend




DECLARATION

I confirm that I wish to enter the “Sleep Out to Kit Out” event and that the information I have given above is correct. I have read and agreed to abide by the terms and conditions of the event accompanying this registration form. I agree that I will seek medical advice from a general practitioner if I am in any doubt as to my physical ability to complete this event. I also confirm that I am aware that any photographs taken during the event may be used to publicise this event and the work of Cannock Rotary Club and the Rotary Club of Stafford.



Signature ………………………………………………………………     Date ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,


To enter this event please print this form.  Complete the form and send it by post to Mr L Lee, White Lodger, Chase Road, Brocton, Stafford, ST17 0TL Tel: 01785 664521 email: sleepout2022@gmail.com

Please indicate how you will pay your £10 registration fee>

I have enclose my registration fee of £10 and a cheque made payable to The Rotary Club of Stafford or I have sent a BACS payment to the Rotary Club of Stafford.

Sort Code : 40 43 03   Account Number: 81396846   Quote reference: “Sleep out”

An official sponsorship form can be found at Staffordrotaryclub.org.uk or you might like to set up your own “Just Giving” or similar on line donation page. Pictures and text to promote your site can also be found on the club’s website.

Sponsorship forms and money should be sent in the same way on competition of the Sleep Out.



Sleep Out to Kit Out  - REGISTRATION FORM