Friendship Walks Form

All fields marked with an asterix * are mandatory

I would like to: *
Title: *
First name: *
Last name: *
Organisation/ group (if applicable):
Address: *
Postcode: *
Daytime telephone number: *
If you would like to receive information via email please provide email address: *
How did you hear about Friendship Walks? *
Date of birth: (dd/mm/yyyy):
I would like to: * Receive an Organise a Friendship Walk information pack
Please use this box to ask questions or comment upon the Friendship Walks:
Data protection: The personal information you provide will be held securely in accordance with our internal policy and the Data Protection Act 1998. For more details please contact Data Protection, Breast Cancer Campaign, Clifton Centre, 110 Clifton Street, London, EC2A 4HT or see our website www.breastcancercampaign.org. Keep in touch: We will write to you from time to time to update you on Breast Cancer Campaign's progress and successes. If you would prefer that we didn’t write to you tick here. We may allow some carefully selected organisations to write to you in the future, if you would prefer to be excluded from this activity tick here.