Charity Tandem Booking Form

Course

Title

Forename*

Middle Name

Surname*

Total In Group

Sex

Date Of Birth*

Height

Weight

Important: Max. Weight Limit for Men 15st & Max. Weight Limit for Women 13st

Address 1*

Address 2

Address 3

Town*

County

Postcode*

Phone*

Mobile

Email*

Important: please don’t forget to enter your e-mail address as we can then send you all the information you need by e-mail. Your e-mail address will only be used for booking purposes.
Remember only weekend & bank holiday dates are valid.

Please Indicate Your Preferred Charity


Preferred weekend course date (1st)

Preferred weekend course date (2nd)

How did you hear about us?


		Time of day

	Time of day


	Please use the space below to give us any further information that you feel is relevant: