Buckingham Swimathon Donation Form (Payment Via Janis Harding, Buckingham Rotarian)

Swimathon Registration Form Please complete all boxes marked required

Register yourself (or your team) to take part in this year's Buckingham Swimathon.

Select the amount for the number of people you would you like to register for. £5 per person.

Donation Amount:

£ 5

Name of Swimmer *

Team Name

Group, Club or Solo swimmer *

Telephone Number *

Address *

How many other team members?

Preferred Start Time

50% of my sponsorship money to go to:

Have you got a special reason for taking part?

If yes, would you be happy for your story to be used to help publicise the event? Yes No

If yes, would you be happy for your story to be used to help publicise the event?

Any special requirements, medical conditions or details for above questions

Emergency Contact Name: (required) *

Emergency Contact Phone:(required) *

Age Requirement

Age Requirements (required) * I am over 16 years old on the day If not, my application is being completed by my Parent or Guardian

Parent / Guardian Name

What is your name?

We’ll never share this information with anyone.

Personal Info

First Name *

Last Name

Email Address *

Select Payment Method

Donate with Offline Donation
Paypal (via Janis Harding, Buckingham Rotarian)

Make your donation quickly and securely with PayPal

How it works: You will be redirected to PayPal to pay using your PayPal account, or with a credit or debit card. You will then be brought back to this page to view your receipt.

Terms

Show Terms

Agree to terms?

Donation Total: £5