Fundraising Form The Form: Name Email Address Home Phone Mobile No. Do you know what you would like to do to raise funds for Lighthouse Trust? Do you know what you would like to do to raise funds for Lighthouse Trust? Yes No If yes, please state event details, as much as you know. Date of Event Would you like the event to be published on our website Would you like the event to be published on our website Yes No Declaration (please tick) Declaration (please tick) I acknowledge that the group/organisation/individual is undertaking this activity entirely of their own risk and that Lighthouse Trust (Northampton) shall not be liable for any injury or loss that might occur as a result of this event. 13 + 2 = Submit Form