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First Name
Sign up your school, college or university here for North Staffordshire's biggest fundraising day Bring a Pound Day and tell us what you'll be doing!
Surname
Address 1
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Title
Address 2
Address 3
Town
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Contact Phone No (W/ STD code)
Position
Name of School, college or university
Address 4
Number of pupils and teachers taking part
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Would you like a Signal Presenter to visit on and before the day?*
* All visits are subject to availability and a representative from Signal Radio will contact you on one of the ways you have submitted prior
What are you planning to do on the day? e.g. dress up\dress down, cake sale etc.
Please note that by submitting this form you are consenting for DMH to share your information with Signal Radio
How much are you aiming to raise?
Department
Are you a
Mobile number (if applicable)
Do you or any of your pupils have a special reason for getting involved for Dougie Mac?