First Name *

Last Name *

Email *

Your address

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City / Town *

Postcode *

County *

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Please tell us your connection to our work:

I am a parent or guardian of a baby born premature or sick

I am a friend or family member of someone who had a baby born premature or sick

I am a bereaved parent

I am a neonatal healthcare professional

I am a healthcare professional, but don't work directly in neonatal care (e.g. a midwife or GP)

I was born premature or sick

Other

If other, please give details

If other, please let us know where you heard about this event.

By signing up to Bliss Little Lights I agree all funds raised must be for Bliss. *

Yes, I agree.

Date of your walk

What type of walk are you doing? *

Solo walk

Hosting a group walk to invite others to join

Not sure yet

The name(s) as you wish it to appear on your fundraising certificate

Let's keep in touch

Your support helps the most vulnerable babies in the UK. We’d love to keep you updated with news about our work and ways you can get involved with Bliss.

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We (Bliss and Bliss Scotland) promise to keep your details safe and never pass them on to third parties for marketing purposes. Find out how we look after your personal data in our Supporter Promise. If you have provided a postal address we may occasionally contact you by post, but you can opt out of all communications from Bliss at any time by calling us on 020 7378 1122 or emailing us.

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Yes, I’d like to hear from you by text

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