First Name
(Required)
Surname
(Required)
Email
(Required)
Phone
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Where will we send your t-shirt?
T-Shirt Size
Small
Medium
Large
XLarge
XXLarge
Registration Fee
Quantity
(Required)
Includes t-shirt & fundraising pack posted to you.
Price:
25,00 €
Quantity
Additional Donation Amount: (Optional)
Total Amount:
Credit Card
(Required)
Card Details
Cardholder Name
Cheshire Ireland would like to keep you updated on how you can continue to support their work.
Email
Phone
Please select how you would prefer Cheshire Ireland to get in touch with you:
