2022 January Fundraiser Registration

First Name *

Last Name *

Email *

Phone

How did you hear about the challenge?

I have read and understood the terms and conditions and would like to apply for a place in the '12,000 Steps a day in January' challenge.

I have read and understood the terms and conditions above *

Marketing Permissions

RBLI would like to keep you updated on other fundraising events and our latest news. Please let us know how you would like to hear from us.

Marketing option

Yes, I would like to opt in to email communications (you can unsubscribe at any time)

Registration 2022