Return to :
State Street Caledonian Challenge
The Scottish Community Foundation
126 Canongate
Edinburgh EH8 8DD
Name of marshal: (please print)
Position held during Challenge Check point / or Water Stop:
Name of charity nominated:
a)
b)
c)
Sum out of a total of £150 to be donated:
a)
b)
c)
Address /or contact details: (if known)
a)
b)
c)
If further space is required, please continue overleaf -
Signature of claimant:
Address of claimant:
Official use only
Payment authorised by:
Date: