Event Registration

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Please complete the online form below to submit details of your event/activity to the DLRAA, or download an event application form if you prefer to submit your application form by post.

Event Details

What event/activity are you planning to do?

Date and Time:

Venue:

Your Details

Title: *

Full Name: *

Address: *

Postcode: *

Telephone Number:

Email Address: *

Date of Birth:

We will keep your details to inform you of future events. Your details will not be passed to any third parties. If you do not wish us to keep your details, please tick the box.

Future events:

Do not keep my details for future events.

Declaration

I understand that because I or people under my control will be organising this event/activity I do so at my own risk and cost. I understand that Air Ambulance Public Liability Insurance does not cover me, my helpers or guests. I agree to pay all proceeds to Air Ambulance.

Agree: *

I agree to this declaration.

If you are under 18 years of age, please complete the a printed form, and have your parent or guardian countersign it before posting it back to us.

By submitting your application, you agree to our Terms & Conditions.