Offline Form Registration form Name: Email: Address: Phone: Area funds are to be raised: What event are you planning to hold: Date of event: Fundraising target: Is there anything else we can assist you with your fundraising: By submitting this form I agree to send in all monies raised in relation to my fundraising efforts and any relevant sponsor forms or documentation to Leicester Hospitals Charity within a reasonable amount of time following completion of my fundraising. I confirm I have read the above declaration: Yes
0116 258 8709
uhl-tr.lhcharitymailbox@nhs.net
