<p> CSSC EVENT ENTRY FORM</p><p>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</p><p>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.</p><p>Section 1: Your Details (Delete as applicable) Mr/Mrs/Miss/Ms/Other Forename: Surname: Male/Female Date of birth: Address </p><p>Postcode CSSC membership no. Home Telephone no. Work Telephone no. Mobile Telephone no. Email </p><p>Next of Kin NoK Contact Tel. no. Are you willing to lift share? Yes No </p><p>How will you be travelling to the Event? ...... </p><p>Section 2: Cost </p><p>CSSC Members £150</p><p>Price includes guides, accommodation and self-catering meals.</p><p>Full payment required by 26th May 2017. No refund will be given after the closing date.</p><p>Section 3: Payment</p><p>Total amount enclosed: Method of payment:</p><p>To pay by credit card please call 01494 888407 quoting the name and date of the event. </p><p>Paying by BACS: HSBC, Sort Code: 40-02-06, Account Number: 50232572 Please quote SNOW HILL followed by YOUR SURNAME as a BACS Reference.</p><p>Cheques should be made payable to ‘CSSC Ltd’ and should accompany the entry form. Please do not send cash. </p><p>• 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.</p><p>Section 4: Medical and Dietary Requirements Medical: Please let us know if you have any physical or medical conditions Yes/No (Delete as applicable)</p><p>If yes, please give details Any Dietary Requirements</p><p>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.</p><p>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.</p><p>Any enquires directly linked to the event please contact Clair Wilson on 07817 000406 or e-mail [email protected] </p><p>Signed: Date: </p><p>Please send all entries and payments to: [email protected] </p><p>Rebecca Brand CSSC Event Team Compton Court 20-24 Temple End High Wycombe Bucks HP13 5DR</p><p>Tel: 01494 888407 Photocopied or Electronic forms will be accepted</p><p>Office use only: Date entry received: …………………. Date acknowledgement sent: ………………….</p>