Form guest test – purplelights

Name of Light up

Search for and select the location of the landmark lighting up in the box below. For personal light ups enter your town or city (but not your exact location) or search on the map and click where the light up is.

Light up map

× Reset location

Type of Light-Up

1. Your Details

Please take a moment to fill in the form below and we’ll be in touch using the contact details you’ve provided with support and information about your light up. We’ll also keep you updated about this year’s campaign.

If you want to unsubscribe from updates then you can do so within the emails we send you or by emailing info@purplelightsuk.org.

First Name

Last Name

Phone number

2. About your light up

The following information will be published on the website.

City/Town

Organizer

LANDMARK ONLY: Light up organised by (enter names as you would like them to appear on the map, enter your name if you are the organiser, or the name of the person responsible)

Thanks to...

LANDMARK ONLY:use this box to thank a person/company who assisted you with your light up (please note this will be displayed on the website)

Start Date

End Date

Time of light up

Updates/Latest News

Yes

Do you want to be kept updated, by email, about current and future Purple Lights for pancreatic cancer campaigns and hear about opportunities to tell your story?

Notify me when purple light is published