Application UK Events

Charity fund raising event in aid of Barts and The London Children Hospital .

Can be used for postal or on-line applications. Do not use for international treks

How did you hear about this event

Your personal details

To avoid spam to our database please copy this GTB64 into this box

E mail address - Will only be used to contact you if there is a problem with your application

First name

Surname

Address Line 1

Address Line 2

Town

County

Postcode

Date of Birth

/ /

Male / Female

Contact phone number

Event details

Event name

Start date	Check Dates
Extra information we need for the Ben Nevis challenge
Do you require transport to Fort William
If Yes

Start date	Check Dates
Extra information we need for the Ski Italy holiday
Personal details
Departure airport
Ski School
Ski ability
Room partner - single rooms not available

Start Date	Check Dates
Extra information we need for the Multi Activity weekend
Personal details
Can you swim at least 50m
Do you want us to arrange your hotel	- If yes
Room partner (if applicable)

Deposit payment

How do you wish to pay your deposit

On-line = Card Only / Postal = Card or Cheque

Please ensure that you read the terms and conditions BEFORE you agree to them.
I declare that I have read and agree to the Terms and Conditions relating to this event. I further declare that I have no medical or other conditions that may in any way affect my participation in this event and that I will notify the organiser should such a condition become apparent after my booking has been accepted.

Confirm your agreement to the terms and conditions

Card details

NOTE - The address given above MUST be that shown on your card statement

Card Type
Start Date
End Date
Card Number
Security Code	(last 3 digits on signature strip)
Issue number	(Maestro and Switch only)

Bookings are NOT confirmed until we receive
confirmation from your card issuer of your booking fee payment.

Press ONCE to send application