Memory Walk & Jog - Register for DIY MW&J

Personal details

Title *

First Name *

Last Name *

Gender *

Age

I’m organising this on behalf of

Company

Group

Address *

City *

State *

Postcode *

Phone Number *

Email *

Please send me updates about Memory Walk & Jog and Dementia Australia

Event details

Name of walk or run *

Proposed date of walk or run *

Proposed start time

Proposed end time

How many people are you hoping will attend?

Proposed location or course of the walk or run *

Name of local council where walk or run is being held

Has the local council already approved the walk or run?

How do you intend to promote your walk or run?

Facebook or social media

Emails to friends and family

At work

Local sports groups

Posters in the local shops

Newspaper article

Radio interviews

Advertising

Council “what’s on”

Other

How do you intend to fundraise for your walk or run?

People will pay to enter

Participants will fundraise

Raffle

Food stalls

Local organisations will sponsor the event

Other

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Event webpage

Please provide a brief description of your walk or run. This will appear on your online event page. *

If you would like us to share your story on your event page or use it to help get media coverage for your event, please check the box.

Attach a map of your course route (if available)

Attach sponsor logos (if applicable, max 3)

Do you need the ability to sell tickets or for people to pre-register for your event? *

Please indicate the ticket types and prices you would like to sell below:

Bub (0-5) - $0

Child (6-17) - $10

Adult (18-59) - $20

Senior (60+) - $10

Family (2 adults, 2 concessions) - $50

Dog - $5

If you would like to offer different ticket types, please specify the ticket names and prices.

I understand that by organising this event, I am making a commitment to hold this as a fundraising event, not just an awareness event. *

I understand that Dementia Australia cannot pay for my event costs but that they will assist and support me throughout the journey. *

How much money do you hope to raise?

I have read and will abide by the Terms and Conditions *

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