Card Number

Start date Expiry date Issue no. (maestro only)

CVC Number (last 3 digits of the number above your signature strip)

(maestro only)

I would like to take part in the 5k 10k

I enclose my entry fee £10 for an adult £5 for a child (under 16)

I would also like a Clatterbridge T-Shirt and enclose a donation*

S M L XLPlease make cheques payable to The Clatterbridge Cancer Charity or complete your credit/debit card details:

If you do not want to hear about future charity news from The Clatterbridge Cancer Charity please tick here

If you do not want to hear about future charity news from Liverpool Unites please tick here

Please return to: Charity Office, The Clatterbridge Cancer Centre, Clatterbridge Road, Wirral, CH63 4JY

Organised in partnership

Registered Charity Number: 1051727

Lets go!

Charity OfficeThe Clatterbridge Cancer Centre

Clatterbridge RoadWirral

CH63 4JYfundraising@clatterbridgecc.nhs.uk

To find out more about our Mersey Walk of Hope

visit

www.clatterbridgecc.org.uk or call us on

0151 482 7948

Mersey Walk of HopeFriday 26 October 2012

Pier Head, Liverpool Waterfront

*Suggested minimum donation £5

Mersey Walk of HopeJoin us for the

The Clatterbridge Cancer Charity is once again joining forces with Liverpool Unites for Alder Hey to organise the second Mersey Walk of Hope!Join over a thousand people as we walk to raise money for two of the region’s best loved hospitals. Anyone can take part in this moonlit walk along the world-famous Liverpool waterfront, with a choice of brand new 5 and 10k routes.Look out for the Juice FM stage and Leanne from Juice FM Breakfast. With live music and fire-eaters entertaining you at the start and a delicious hog-roast* to welcome you across the finish line, this year’s event will be even bigger and better than before.The money raised from the Mersey Walk of Hope will help thousands of cancer patients and children at both The Clatterbridge Cancer Centre and Alder Hey’s Children’s Hospital, funding some of the life-changing appeals that make both hospitals so special in people’s hearts.

Charlie’s StoryWhen Charlie was twelve, his appearance had changed so dramatically in just two months, his parents barely recognised him. He had a brain tumour, thankfully the tumour was successfully removed but four years later the Witters’ worst fears were realised when Charlie was diagnosed with another large tumour.

In the months that followed Charlie had to undergo intensive and often difficult treatment at both The Clatterbridge Cancer Centre and Alder Hey. Thankfully Charlie made a full recovery and took part in last year’s Mersey Walk of Hope to support the two hospitals close to his heart. As Karen, Charlie’s mum, explains “Charlie wanted to give something back to both Alder Hey and Clatterbridge to thank them for the way they have cared for him. Charlie was so grateful that his heart is now set on a career in medicine so he can help others in the future.”

*On sale. Hot drink refreshments will also be available.

The Clatterbridge Cancer Charity

The Charities

The Clatterbridge Cancer Charity is the only charity raising money to directly benefit Clatterbridge cancer patients and their families across the region. By taking part in the Mersey Walk of Hope you will be helping us to offer the most up to date treatment, support vital research, treat our patients with world class equipment and provide life changing support services that would otherwise be unavailable.

Liverpool Unites for Alder Hey Imagine Appeal Liverpool Unites, the official charity of the Liverpool Post and ECHO, has a fundraising target of raising £500,000 for Alder Hey Children’s Hospital. All money raised will be used to build the play areas in the New Children’s Health Park.

Register Now!For safety reasons please complete one form per person. Closing date for us to receive entries is 15 October.

Online: the easiest way to register is at clatterbridgecc.org.ukPost: complete this form and send it to the address overleaf

NAME:

ADDRESS:

POSTCODE:

PHONE:

EMAIL:

If you happy for us to contact you by email, please complete your email addressKnow someone who could help on the night as a volunteer? Get in touch: 0151 482 7948 or circle Yes / NoDo you have a special story to share about taking part? Yes / No

DECLARATION (this must be completed and signed)

By signing this form I confirm:

• I understand that this is a fundraising event and pledge to raise as much sponsorship as possible• I understand that entry fees are non-refundable as they cover the costs of holding the event• I understand that this is a walk and not a race and that walking at night is potentially hazardous• I am aware that I participate in this event at my own risk and that the organisers cannot be held responsible for any injury, accident, loss, damage or public liability caused or sustained as a result of my participation• I will abide by all the rules and regulations set out by The Clatterbridge Cancer Charity and Liverpool Unites for participating safely in this event• I confirm that I am in a reasonable state of health and fitness; if I have concerns about my physical condition to take part in this event I will consult my doctor first• I understand that The Clatterbridge Cancer Charity and Liverpool Unites may take photographs of me participating in this event and permit the charity to use these images for promotional purposes• If I am signing for a child I give permission to use their image• If I’m under 16, I will be accompanied by a responsible adult who will supply written permission for my participation• That I have read and accepted the conditions of entry to the Mersey Walk of Hope and the rules and regulations of this event

SIGNATURE:

DATE:

Please complete your payment details overleaf…

PlayHelps children come

to terms with a difficult diagnosis£1.4m

We need to raise

this year!