Training Application Form s2

Greater London Middlesex West County Scout Council ADULT LEARNING APPLICATION FORM

Please complete the fields marked * Membership number (if known – see your membership card or the wrapper of Scouting Magazine) Surname:* First Name:* (Or preferred Name) Title: Dr Mr Mrs Ms Miss Module/ Course Name:* Dates & Location:*

E-mail address: (please print clearly) Telephone No: Home Mobile Address: *

Post Code: Preferred Method of Contact: Any Mail Email Scouting Role:* Group: District:* County: * Previous Scouting or other relevant experience (ie how long have you been a leader) Accommodation: Required Not Required (only for weekend courses at Paccar. Bunkhouse with breakfast) Special Dietary Needs:

Further Needs: (e.g. visual, learning and hearing difficulties, religious requirements, etc.) How did you hear about this course? Date of Birth: (day/month/year) Emergency Name: Contact (essential for ALL Telephone: residential events) Address:

This form can be downloaded from: www.glmwscouts.org.uk/glmw_application_ac.doc Your Training Adviser: Name: Address:

Please read and sign below

CANCELLATIONS: Please notify your Local Training Administrator/ Local Training Manager as soon as possible if you are unable to attend. Training within GLMW for GLMW adults is FREE, however charges may apply following non-attendance.

OUT OF COUNTY APPLICATIONS – please send directly to the County Training Manager (Stuart Hogge, 42 Morley Crescent West, Stanmore, Middlesex, HA7 2LW)

Cheques should be made payable to: Greater London Middlesex West Scout Council (G.L.M.W. Scout Council)

JOINING INSTRUCTIONS: These will be sent to you approximately two weeks before the start of the course. Should you not receive them please contact your LTA or LTM.

Signature...... Date......

This form should now be returned to the Local Training Manager

Andi Childs 76A Slough Road Iver Heath Bucks SL0 0DY

[email protected]

The information on this form will be stored under Data Protection and used for SCOUT ADULT LEARNING PURPOSES ONLY Office Use Only: Out of County Only: Paid: Received: Acknowledged: