Name:        ................................................................

Address:    .................................................................

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Phone Number:    .....................................................

Entry Fee:            £4.50  Cheques made payable to N W Tandy
 

Accomodation (if required)

Please contact the Hotel direct (see details sheet)

I certify that I have read and fully understand and agree to abide by the conditions of entry and will comply with any instructions given by the organiser before or during the walk.

I enclose entry fee and a stamped addressed envelope.
 
 

If under 18 the following section must be completed by a parent or guardian:-

I confirm that I am the aove applicant's legal parent/guardian (delete as necessary) and I undertake to accompany them through the event.

Signed ................................................

N W Tandy
47 Lightwoods Road
Pedmore
Stourbridge
West Midlands
DY9 0TR