Organising your own event?

Please fill in this form so that we can support your fundraising.

Title	Select Mr Mrs Ms Miss Dr Professor Reverend
First name
Surname
Date of birth	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1 2 3 4 5 6 7 8 9 10 11 12 / 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Gender	Select Male Female
Email
Postcode
Address line 1
Address line 2
Address line 3
Address line 4
City
County
Country	Please select Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua And Barbuda Antilles Argentina Armenia Aruba Australia Austria Azerbaijan Azores Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda BFPO Bhutan Bolivia Bosnia And Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Ceuta Chad Channel Islands Chile China Colombia Comoros Congo Cook Islands Costa Rica Cote D'ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Ireland (Republic of) Ireland (Northern) Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic Korea, Republic Of Kuwait Kyrgyzstan Lao People's Democratic Latvia Lebanon Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia, Fyr Madagascar Malawi Malaysia Maldives Mali Melilla Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova, Republic Of Monaco Mongolia Montserrat Morocco Mount Athos Mozambique Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Norfolk Island Northern Mariana Islands Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Lucia St Vincent/Grenadines Samoa San Marino Sao Tome And Principe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia (Slovak Republic) Slovenia Somalia South Africa Spain Sri Lanka St Pierre and Miquelon Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province Of China Tajikistan Tanzania, United Republic Of Thailand The Aland Islands Togo Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States US Minor Islands Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Western Sahara Yemen, Republic Of Yugoslavia Zaire Zambia Zimbabwe
Home number
Mobile number
Type of event	Select Running Cycling Walking Music Water-related Other If other, please state:
Brief description of planned event More info	Characters left
Provisional date	1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / 1 2 3 4 5 6 7 8 9 10 11 12 / 2008 2009 2010 2011
Proposed venue
Would you like a fundraising pack? More info	Yes, I would like 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 packs.
T-shirt(s) required? (A donation towards the cost of producing these t-shirts is not essential but would be appreciated. Suggested amount: £5)	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20  Small 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20  Medium 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20  Large 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20  X Large
How much do you think you will be able to raise?	£
If there are any costs associated with your event, how do you plan to cover them?	Characters left
Where did you hear about WaterAid?	Select Work School Church A club Water bill Website Other If other, please state:

	I have read the legal and safety advice on the website and have adequate insurance for this event.
	Your support makes our vital work possible. We'd like to keep in touch with you to tell you more. If you don't want to hear from WaterAid and WaterAid Trading Ltd just tick this box.