Pure Mile Application Form

Name of Pure Mile (required)

Total Number of Miles (required)

Please give details of 2 people who we can contact in relation to the competition

Person One:

Your Name (required)

Address (required)

Tel (required)

Mobile (required)

Your Email (required)

Person Two:

Your Name (required)

Address (required)

Tel (required)

Mobile (required)

Your Email (required)

What aspects of The Pure Mile would you like to focus on:

LitterAnti-Dumping InitiativeClean Up The UplandsCommunityEducationNatural HeritageBuilt/Social Heritage

Additional Information:

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