G

1
Abseil 2005
In association with
G
Adrenaline Junkies - 'take the leap' and help
Action Cancer!
Bored with the routine of everyday life? Fancy a
change from the norm? Well Action Cancer is
offering you the chance to do just that! On
Saturday 18th June, 100 adventure seeking people
will take the leap and abseil down the Europa
Hotel in Belfast, one of the tallest buildings in
Northern Ireland! Besides the thrill of the
event, participants will be helping those living
with cancer in their community by raising money
for Action Cancer.
So if you are over 14 years old and ready for a
challenge then simply complete the enclosed
registration and medical forms and send with your
25 deposit. Places are limited and based on a
first come first served policy, so to guarantee
your place register today!
2
Registration Sponsorship If you would like to
participate in Abseil 2005 on behalf of Action
Cancer, simply complete the registration and
medical form. Please feel free to photocopy the
form for your family and friends! The
registration fee for this event is 25 per person
and should be returned with the registration
form. Each participant has to raise a minimum
sponsorship of 75. Sponsorship forms should be
enclosed with this pack if they are missing or
if you need more, please call Nicola on 028 9080
3344 and we will forward extras.

• Action Cancer
• Cancer has overtaken heart disease as the biggest
  killer in Northern Ireland, with one in three
  people given a diagnosis of cancer at some stage
  in their lives. Action Cancer is on hand to
  provide advice and support.
• The money raised by your abseil will be used to
  help Action Cancer fund its life-saving services.
  These services include the following
• Womens early detection clinics for breast and
  cervical cancer.
• A mobile unit that travels into community and
  rural areas to provide breast and cervical
  screening
• Mens Health programme early detection clinics
  for testicular and prostate cancer
• Support Services for all people affected by
  cancer including relatives, carers and health
  professionals. The services available are  
• One to one counselling carried out by trained
  counsellors
• Complementary therapy service including
  reflexology, massage relaxation
• Yoga and meditation
• Action Cancer also supports cancer research
  projects in local universities and funds part of
  the Northern Ireland Cancer Genetics Service.
• Action Cancer relies on the generosity of the
  general public. We must raise 2.6 million each
  year to maintain our life-saving services. All of
  the funds raised by the charity are spent in
  Northern Ireland.
• We hope you will take part in this abseil and
  help Action Cancer raise much needed funds to
  continue the fight against cancer in Northern
  Ireland.
• In the meantime, if you have any questions or
  queries about the abseil, please call Nicola on
  028 9080 3344 or e-mail ndennison_at_actioncancer.org
  .

3
Abseil 2005
REGISTRATION FORM
I wish to register for Action Cancers Abseil
2005. I enclose the 25 registration fee for
the participant named below Name
__________________________________________________
_____ Contact Address____________________________
___________________ ______________________________
Town___________________________ County____________
____________Postcode_______________________ Teleph
one Number_______________________________________
______ Email ____________________________________
____________________ Date of Birth
__________________________________________________
I would like to pay by
I enclose a 50 cheque / postal order made
payable to Action Cancer Please debit my account
for 50
Card Type Mastercard
Visa Switch Card No.
__ __ __ __ __ __ __ __ __ __ __ __
__ __ __ __ Expiry Date __ __ / __ __
Issue No. __ __ __ __
Please make cheques payable to Action Cancer and
return to 1 Marlborough Park, Belfast, BT9 6XS
Please feel free to photocopy these forms for
your friends!
4
ABSEIL MEDICAL FORM Group Name Action Cancer,
18th June 2005
Personal Details
Name _________________________________________
_________________________________________ Address
_________________________________________________
_________________________________
________________________________________________
Postcode ______________________________ Date
of Birth ____________________ Age
____________ Contact Tel _____________________
_________ If under 18 years old you need to ask
for consent from your parent / guardian
Person to Contact In An Emergency
Name ____________________________________________
________________________________________ Address
__________________________________________________
________________________________ _________________
_______________________________ Postcode
_______________________________ Home Phone
________________ Work Phone ________________
Mobile Phone _____________________
Medical Statement
Name of Doctor __________________________________
__________________________________________ Address
________________________________________________
__________________________________ _______________
__________________________________________________
_________________________ Telephone No
____________________________ Do you have any of
the following? (Please delete as
appropriate) Any major illness Yes /
No Pregnancy Yes / No Blackouts / Headaches
/Migraine /Dizziness Yes / No Epilepsy Yes /
No Allergies to bites / Food / Medicines Yes /
No Diabetes Yes / No Asthma / Bronchial
Illness Yes / No Heart Complaints Yes /
No Recent injuries / operations Yes / No Back /
Neck Complaints Yes / No Any condition requiring
regular treatment Yes / No Details of the above
or any other condition____________________________
___________________________ ______________________
__________________________________________________
_________________ Details of any Medication
__________________________________________________
__________________ _______________________________
__________________________________________________
________ (Please bring any medication/inhalers
etc. with you on the day) I consent to emergency
medical treatment being given if deemed necessary
during the course of the abseil YES / NO
Medical Practitioner Details
If you answer YES to any of the above
questions, please get this form signed / stamped
by your doctor in the space below.
Declaration
I the undersigned ________________________________
__________________________ accept the conditions
of this event and confirm that I am over 18 /
giving consent and am able to take part in the
abseil run by Belfast Activity Center / Action
Cancer, and to the best of my knowledge, the
above details are correct. If you are under 18
years old please ask your parent / guardian to
sign below. SIGNED _____________________________
______________________ DATE ___________________

Charity Reg No XN48533