Venue / Elterwater, Lake District
Date of event / Friday 7th – Monday 10th July 2017
Closing date for entries / Wednesday 5th April 2017
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.
Mr/Mrs/Miss/Ms/Other / Forename: / Surname:Male/Female / Date of birth:
Address
Postcode
CSSC membership no.
Home Telephone no. / Work Telephone no.
Mobile Telephone no. / Email
Next of Kin / NoK Contact Tel. no.
Are you willing to lift share? / Yes No
How will you be travelling to the Event? ......
Would like to share a room with…………………………………………………………………………….…………….
Section 2: Cost & Equipment Hire
A non-refundable deposit of £75 per person is required to hold your place on the trip. Final payment require 2 months prior
CSSC Members: £160.00
Twin room supplement: £20.00pp
Price includes accommodation, meals and walk guides.
Section 3: Payment
To pay by credit card please call 01494 888407 and quoting the name and date of the event.
Paying by BACS: HSBC, Sort Code: 40-02-06, Account Number: 50232572
Please quote ELTER HILL followed by YOUR SURNAME as a BACS Reference.
Cheques should be made payable to ‘CSSC Ltd’ and should accompany the entry form. Please do not send cash.
Total amount enclosed: / Method of payment:• 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.
Section 4: Medical and Dietary Requirements
Medical: Please let us know if you have any physical or medical conditions
Yes/No (Delete as applicable)
If yes, please give detailsAny Dietary Requirements
Section 5: Level of Experience
Beginner Intermediate Expert
Please give brief description of summer and winter experience:
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.
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.
Any enquires directly linked to the event please contact Clair Wilson on 07817 000406 or e-mail
WITHDRAWALS: Before Wednesday 5th April 2017 a full refund will be given if your place can be filled. No refund will be given after this date. Withdrawals must be e-mailed.
Signed: Date:
Please send all entries and payments to:
Rebecca Brand
CSSC Event Team
Compton Court
20-24 Temple End
High Wycombe
Bucks
HP13 5DR
Tel: 01494 888407
Fax: 01494 888437