Own Place - Event notification

Own Place - Event notification

You will need to be aged 16 or over to complete this form.
Please indicate the name of the event you have secured your own place in*

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Date of event

DayMonthYear
Date
Personal details
Name*

PrefixFirst NameLast Name
Preferred Name
Address*

Address Line 1

Address Line 2

City/TownCounty

PostcodeCountry
Email*
example@example.com
Telephone number*
Is this your work, home or mobile?*
Age disclaimer*
Place of Work / Education
Does your place of work offer any form of match funding?

YesNo

Keeping in touch

We’d love you to be part of the Princess Alice Hospice supporter community, but if we don’t have your permission, we can’t get in touch with you to share our latest news, campaigns and information about how you can support our work.
Would you like to hear from us by email?*

YesNo
Would you like to hear from us by post?*

YesNo
Would you like to hear from us by phone?*

YesNo
Rest assured, we never share, swap, rent or sell our supporters’ details to other charities or third parties for marketing purposes. You can read how we manage and respect your data in our Privacy Notice at www.pah.org.uk/privacy

If you’d like to change your permissions at any time please contact our Customer Experience Team on 01372 461808 or customerexperience@pah.org.uk
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