Section 1: Your Details (Delete As Applicable) s1

CSSC EVENT ENTRY FORM

Event Snowdonia Training Weekend Venue Cwm Glas Mawr, LL55 4UL Date of event Friday 9th June – Sunday 11th June 2017 Closing date Friday 26th May 2017

Please complete all sections in BLOCK CAPITALS. CSSC membership numbers must be included. You may find it helpful to ‘Tab’ from one field to another.

Section 1: Your Details (Delete as applicable) Mr/Mrs/Miss/Ms/Other Forename: Surname: Male/Female Date of birth: Address

Postcode CSSC membership no. Home Telephone no. Work Telephone no. Mobile Telephone no. Email

Next of Kin NoK Contact Tel. no. Are you willing to lift share? Yes No

How will you be travelling to the Event? ......

Section 2: Cost

CSSC Members £150

Price includes guides, accommodation and self-catering meals.

Full payment required by 26th May 2017. No refund will be given after the closing date.

Section 3: Payment

Total amount enclosed: Method of payment:

To pay by credit card please call 01494 888407 quoting the name and date of the event.

Paying by BACS: HSBC, Sort Code: 40-02-06, Account Number: 50232572 Please quote SNOW HILL followed by YOUR SURNAME as a BACS Reference.

Cheques should be made payable to ‘CSSC Ltd’ and should accompany the entry form. Please do not send cash.

• Anyone who is not a member of the CSSC and wants join can obtain a membership form from Rebecca Brand on 01494 888407 or the organiser (if different). If you are unable to quote your CSSC number e.g. lost card, a form for a replacement card can be found online or please contact our customer services team on 01494 888444.

Section 4: Medical and Dietary Requirements Medical: Please let us know if you have any physical or medical conditions Yes/No (Delete as applicable)

If yes, please give details Any Dietary Requirements

IMPORTANT: These events are active and participants should be aware of the physical activities involved. CSSC reserves the right to cancel the event if under subscribed.

All CSSC members taking part in the event are covered by CSSC Sports and Leisure Public Liability Insurance. Please note that this policy is NOT a Personal Accident Policy. Members are encouraged to take out their own insurance policy.

Any enquires directly linked to the event please contact Clair Wilson on 07817 000406 or e-mail [email protected]

Signed: Date:

Please send all entries and payments to: [email protected]

Rebecca Brand CSSC Event Team Compton Court 20-24 Temple End High Wycombe Bucks HP13 5DR

Tel: 01494 888407 Photocopied or Electronic forms will be accepted

Office use only: Date entry received: …………………. Date acknowledgement sent: ………………….