BUPA Great North Swim

22 - 24 June 2012

Set in the picturesque waters of Lake Windermere, the British Gas Great North Swim is the UK’s biggest outdoor swimming event. Now run over three days swimmers can choose from three different distances (1 mile, ½ mile, or 2 miles). This is a fantastic event for all swimming abilities and gives both spectators and competitors the chance to enjoy the majestic beauty of the English Lake District.

SIA guaranteed entries have now opened! A registration fee of £30 will secure your place, and the minimum fundraising target is £150 – just fill out the registration form below - you will receive a confirmation email to say you have registered - you will then need to click on the link provided in the email to pay your registration fee or alternatively you can download the application form by clicking here

Alternatively, please apply for your own place in the event, and once your entry is confirmed, just fill out the registration form below to swim for SIA! As an own place supporter, you're free to raise as much as you can.

To find out more please call us on 0845 071 4350 email fundraising@spinal.co.uk or chat to us online by clicking the chat online above.

Write to SIA:

SIA House

2 Trueman Place

Oldbrook, Milton Keynes

MK6 2HH

United Kingdom

Call SIA:

Tel: 0845 678 6633

Fax: 0845 070 6911

Fundraising Hotline: 0845 071 4350

Text SIA followed by your message to 81025

Email: sia@spinal.co.uk

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Race Entered
Charity Place/Own Place	Charity Place - �30.00 Registration fee and a minimum sponsorship of �150 to be raised Own Place
Title	Mr Mrs Ms Miss Dr Other
First Name
Last Name
Address
Postcode
Date of Birth
Tel No:
Mobile Number
Email address:
Have you take part in an SIA Event before?
If yes, which event and when?
T - Shirt Size
Name of Employer
Type of Business
Position Held
Will your employer allow staff fundraising to help
Is there a company newsletter/intranet/magazine
If Yes, then please let us know editorial details

How did you hear about this challenge?
Medical History and Fitness Confirmation	A challenge of this nature is a strenuous activity and the decision to swim should not be taken lightly. If you are not a regular swimmer you should seek professional advice about your fitness and training requirements If you are over 60 years or if you have any medical conditions that could be adversely affected by exercise, particularly a heart condition, or if you are in doubt about your health, you must obtain a medical certificate from your doctor. Please confirmthat to the best of your knowledge your general state of health and firness is good and you take full responsibility for yourself

I will agree to pay the appropriate registration fee for the charity place for the race I wish to take part in. I commit to raise the minimum sponsorship for the charity place for the race I wish to take part in. I will ensure that the minimum sponsorship is received by SIA no later than 4 weeks after the event. If I have secured my own place then I commit to raisiing as much as I can. You will be entitled to a full fundraising pack and T-Shirt. I will be over the age of 18 on the day of the event. I understand that all runners take part at their own risk, and I agree to the terms and conditions stipulated by the race organiser (a full set can be sent on request) All funds raised for SIA through the event must be payable to SIA. I consent to SIA to contacting me via telephone, letter or email for any matter relating to my fundraising and my participation in this race. I give SIA permission to use any photographs/videos taken of me to raise awareness and/or funds for its work and/or events

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BUPA Great North Swim

22 - 24 June 2012

BUPA Great Swim Series Form

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