Winter Meet 2018 Booking Form

Size: px
Start display at page:

Download "Winter Meet 2018 Booking Form"

Transcription

1 Winter Meet 2018 Booking Form Important notice for all course participants - Please read carefully INCLUDE SHARING TRAVEL DETAILS A good level of fitness is essential all courses. We recommend that you allow yourself sufficient time to prepare in order to avoid unnecessary injuries and to get the most from these opportunities. The course fees cover tuition only and do not include travel insurance or cancellation insurance (which we recommend you acquire), food, accommodation or local travel costs. Please allow for this when budgeting. With the exception of ropes, course participants need to provide their own equipment, an equipment list is available on Mountaineering Ireland reserves the rights to cancel any course should there be insufficient numbers. is our primary contact method, so you MUST provide us with a valid address. Please make sure that the address you provide is both spelt correctly and written clearly. We cannot accept liability for any communication problems caused by personal firewalls, spam filtering systems, or your inability to open attached documents. A. Your contact details (please complete all sections in BLOCK capitals) Name Mountaineering Ireland member number Address address Telephone (daytime) Date of Birth Insurance reference number (BMC or other) Telephone (evening) B. Next of kin (person for Mountaineering Ireland to contact in case of accident or emergency) Name Telephone (daytime) Address Telephone (evening) Address Your relationship to this person

2 Please select your course(s) Course Date selection (please tick your preferred date) Registration/registration only - 10 Winter Walking Skills February February Winter Mountaineering Skills February February Winter Climbing Skills (no discount applicable) February February 10% discount on course fees when booked before December 28 st 2017 See details of group discounts in Winter Meet information pack Total course fee due. N.B you must pay for registration if you are not doing a course

3 Please provide an outline of your walking experience (years/months of experience, locations, specific walks) Please provide an outline of your climbing/mountaineering experience (years/months of experience, grade, and areas you have climbed in) Please provide a brief indication of what you hope to get out of the meet Medical and Health Declaration Please declare any previous or current conditions relevant to your planned course(s). Include serious allergies and longstanding injuries. (please use back of form if additional space is required).

4 Accommodation and Transport details If you know when you will arrive and depart from the meet please provide those dates below. Date of Arrival at Inchree Date of Departure from Inchree What accommodation do you plan to use? How will you be travelling to the Inchree Centre? May we pass your details to other MI members to coordinate travel? YES NO Declaration I accept that mountaineering is an activity with a risk of personal injury or death. I agree to abide by the decisions made by the guides regarding the safety of people taking part in the course(s). I have read and agree to the booking conditions listed here and on the web site. The information I have provided is correct and accurate. I do not know of any reason relating to my health that might prohibit me from taking part in my planned course(s). Signed: Date: Payment (There is a non refundable 10 registration fee for all those participating in the meet. This fee goes towards the costs associated with the meet. All participants must be Mountaineering Ireland members. Name on Debit / Credit Card Type of Debit / Credit Card Card Number Please tick appropriate box Billing Address MasterCard Visa Maestro Laser Visa Electron Please call do not include here Valid from date Please call with details do not include here Expiry date CVC number Amount to be paid Please call with details do not include here Total course fee OR 10 Meet only Registration fee (registration fee is only applicable for those not booking onto courses) = Signature Total Amount to be debited Cheque or postal order payment (Payments to be made in Euro only) I enclose a cheque / postal order for the amount the following amount made payable to Mountaineering Ireland. Return completed forms before 15 th January 2018, to: Winter Meet 2018, Mountaineering Ireland, Irish Sport HQ, National Sports Campus, Blanchardstown, Dublin 15, Ireland.

5 Winter Meet Booking Conditions (Please retain this page for future reference) 1. Only bookings from persons over the age of 18 at the time of booking will be accepted. Bookings by or on behalf of persons under the age of 18 may be accepted, when accompanied on the course by either parent / guardian or another person over the age of 18 and subject to written parental consent. 2. When we have received payment and checked all information contained within your booking form, MI will process your registration fee payment. 3. Full payment for courses is due on or before 1 st February If you wish to cancel, the following cancellation charges apply: Candidate cancels up to 6 weeks before course date = 10% administration charge Candidate cancels 6 to 2 weeks before course date = 70% cancellation fee Candidate cancels less than 2 weeks before course date = 100% cancellation fee 5. We reserve the right to cancel any course due to insufficient numbers. In such cases you will be informed on or before 1 st February 2018 and will be refunded the full amount. 6. At the discretion of the course director, client ratios may vary from the stated course ratio to cover eventualities such as staff absence or change of itinerary. 7. All instructors / guides maintain high professional standards of client care and safety. However, you must realise and accept that mountaineering is an activity that carries a danger of personal injury or even death. All clients must be aware of and accept these risks and be responsible for their own actions and involvement in such activities. 8. All information is for guidance only. Whilst making every effort to ensure accuracy, we cannot be responsible for any inaccuracies or alterations beyond our control. Although planned itineraries are adhered to wherever possible, changes may occur to both travel and course itineraries due to external factors beyond the instructors control. In particular, the instructors / guides have total discretion to alter programs at any time in the interest of client safety. 9. Instructors / guides reserve the right to exclude individuals from a planned activity on the grounds of health, safety or the success enjoyment of the rest of the party. Any individuals so excluded are not entitled to a refund. Any individual contravening the decisions or advice of their instructor / guide, or undertaking independent mountain activities during the course shall forfeit all protection and duty of care from the instructor / guide. 10. By making your booking, you understand and accept the booking conditions and agree to abide by them.

DCU. Summer Scholars 2018 Summer Programme (2-week) Application Form. For Secondary School Students (12-17 years) Application Deadlines

DCU. Summer Scholars 2018 Summer Programme (2-week) Application Form. For Secondary School Students (12-17 years) Application Deadlines DCU Summer Scholars 2018 Summer Programme (2-week) Application Form For Secondary School Students (12-17 years) Application Deadlines Early Application Deadline Friday, 26 th January 2018 Financial Aid

More information

DCU Summer Scholars Application Form 2019

DCU Summer Scholars Application Form 2019 DCU Summer Scholars Application Form 2019 PLEASE TYPE OR PRINT LEGIBLY IN INK. BE SURE TO COMPLETE ALL INFORMATION Student Information CTYI Student No. (as per mailing envelope) Full Name Last Name First

More information

CTY Ireland Summer Programme (3-week) Application Form. For Year Olds With exceptional academic ability OVERSEAS STUDENTS

CTY Ireland Summer Programme (3-week) Application Form. For Year Olds With exceptional academic ability OVERSEAS STUDENTS CTY Ireland 2017 Summer Programme (3-week) Application Form For 12-17 Year Olds With exceptional academic ability OVERSEAS STUDENTS Application Deadlines Early Application Deadline Friday, 27 th January

More information

Peru Hiking Challenge 4 13 May 2013 Registration form

Peru Hiking Challenge 4 13 May 2013 Registration form Peru Hiking Challenge 4 13 May 2013 Registration form Please read and complete all sections of this form and return to: Challenge Team, Macmillan Cancer Support, 89 Albert Embankment, London SE1 7UQ Fax:

More information

Vive Le Vélo Champagne Cycle Tour May 2017

Vive Le Vélo Champagne Cycle Tour May 2017 Vive Le Vélo Champagne Cycle Tour 10 14 May 2017 Please return this completed form, along with your cheque/payment confirmation for 75 and passport copy to: The A-T Society, Rothamsted, Harpenden, Hertfordshire,

More information

STUDENT S PARENT S

STUDENT S   PARENT S application form PERSONAL DETAILS (please write clearly using BLOCK CAPITALS) FIRST NAME: FAMILY NAME: MALE: NATIONALITY: FEMALE: DATE OF BIRTH: AGE WHEN COURSE STARTS: NAME OF PARENT/GUARDIAN: CORRESPONDENCE

More information

GoodNeighborInsurance. 690E.WarnerRd.Suite117 Gilbert,AZ85296,USA

GoodNeighborInsurance. 690E.WarnerRd.Suite117 Gilbert,AZ85296,USA GoodNeighborInsurance AFTERFILLING OUTTHISAPPLICATION PLEASEMAIL,FAX,OREMAILSCANTO: GoodNeighborInsurance 690E.WarnerRd.Suite117 Gilbert,AZ85296,USA TolFree:866-636-9100 Phone:480-633-9500 Fax:480-813-9930

More information

Unique Cycling Tours (UCT) Tour Name: Start Date: Group name or travel companions you are booking this tour with:

Unique Cycling Tours (UCT) Tour Name: Start Date: Group name or travel companions you are booking this tour with: Unique Cycling Tours (UCT) Tour Name: Start Date: Group name or travel companions you are booking this tour with: Details of guest travelling One must be completed for each tour guest: Title: First Name:

More information

Membership Application Form

Membership Application Form Membership Application Form Silver Willow in this document means Silver Willow Pheasant Farm LTD. Don Day, Gwen Day and Josh Day NOTES FOR APPLICANTS Please read this form carefully especially the declaration

More information

Membership Application For

Membership Application For Membership Application For Silver Willow in this document means Silver Willow Pheasant Farm LTD. Don Day, Gwen Day and Josh Day NOTES FOR APPLICANTS Please read this form carefully especially the declaration

More information

INSERT FARM NAME HERE

INSERT FARM NAME HERE WELCOME Insert picture or business logo here INSERT FARM NAME HERE Insert TUST TILE IF NECESSARY Australian Business Number (ABN): Insert ABN number here Postal Address: Insert Postal address here Residential

More information

Any fee charged by the member s GP for providing information for completion of the claim form will not be covered.

Any fee charged by the member s GP for providing information for completion of the claim form will not be covered. TRAVEL COVER CLAIM FORM FILLING IN THIS FORM Please fill in this form if a claim is being made from the Worldwide Travel Cover. Complete this form in black ink and as fully and truthfully as possible.

More information

SUREFIRE BUSHCRAFT

SUREFIRE BUSHCRAFT BUSH CRAFT AND SURVIVAL COURSE INDIVIDUAL DETAILS AND CONSENT TO PARTICIPATION Name inc. Title Course Date Course Fee Home Address Course Title Date of Birth: N.H.S. number Blood Group Have you received

More information

Swahili Safari Adventure

Swahili Safari Adventure Swahili Safari Adventure With Sue Verrall 7 June 2019 BOOKING FORM Please read our terms and conditions on the reverse of this booking form before completing the form below. PERSONAL DETAILS: You Travelling

More information

Stand Up On Everest. Telephone Address I do not want any of my contact details passed on

Stand Up On Everest.  Telephone Address I do not want any of my contact details passed on Please read and complete all sections of this form and return to: or email jeremy@standuponeverest.co.uk If you have any questions do not hesitate to call Jeremy on 07713904025 Registration information

More information

People-to-People Travel with the Center for Cuban Studies

People-to-People Travel with the Center for Cuban Studies People-to-People Travel with the Center for Cuban Studies In addition to this application, please send us a copy of your passport information page. Please list the Name and Dates of Program you wish to

More information

Make an exhilarating 10,000ft tandem skydive for Acorns Children's Hospice!

Make an exhilarating 10,000ft tandem skydive for Acorns Children's Hospice! Make an exhilarating 10,000ft tandem skydive for Acorns Children's Hospice! Sunday 30 th September 2012 Hinton Airfield, Brackley Northamptonshire The Acorns tandem 10,000ft freefall skydive! Imagine sitting

More information

UltraCare plan Individual application form

UltraCare plan Individual application form UltraCare 1 January 2012 UltraCare plan Individual application form If you have any questions or need any help completing this form, please contact your adviser or us. You can find our contact details

More information

1 2 3 Complete in full the first 3 forms with your personal, employment and residency information.

1 2 3 Complete in full the first 3 forms with your personal, employment and residency information. InStruCtIOnS It s quick and easy to get your canadian tax refund. Just follow the 3 steps below. 1 2 3 Complete in full the first 3 forms with your personal, employment and residency information. Please

More information

Qualification Awarding body Year

Qualification Awarding body Year Application for Registration as an Chartered Tax Adviser (CTA) Student 2018 Personal Details Title: Surname: First Name: Work Telephone Number: Mobile Telephone Number: E-mail (A valid e-mail address is

More information

LINGNAN UNIVERSITY Office of Mainland and International Programmes

LINGNAN UNIVERSITY Office of Mainland and International Programmes IMPORTANT NOTES Please read the following carefully before you fill in the application. 1 Use of Information in the Application The information provided by an applicant will be used for the following purposes:

More information

Registration Form Pilgrimage 2017

Registration Form Pilgrimage 2017 Registration Form Pilgrimage 2017 In the Footsteps of St Columban August 13, 2017 - September 3, 2017 DUBLIN LUXEUIL BREGENZ DISENTIS OLIVONE BOBBIO MILAN ROME (IRELAND) (FRANCE) (AUSTRIA) (SWITZERLAND)

More information

Overseas study protection plan claim

Overseas study protection plan claim Overseas study protection plan claim Important notice If we accept this form, it does not mean we are taking legal responsibility for your claim. If we ask for any documents as proof or a report, you will

More information

BOOKING CONDITIONS. Your contract is with Undiscovered Montenegro. Registered in England No Your Holiday Contract

BOOKING CONDITIONS. Your contract is with Undiscovered Montenegro. Registered in England No Your Holiday Contract BOOKING CONDITIONS Your contract is with Undiscovered Montenegro Registered in England No 06779866 1. Your Holiday Contract When a booking is made, the lead name on the booking guarantees that he or she

More information

WESLEY HOUSE OF ANGUILLA RENTAL AGREEMENT

WESLEY HOUSE OF ANGUILLA RENTAL AGREEMENT WESLEY HOUSE OF ANGUILLA RENTAL AGREEMENT Owned by Aguillian Luxury Properties, Ltd. USA Office 982 Driftwood Ct. Belvidere, IL 61008 Phone: 815-289-7878 Anguilla Office PO Box 70, The Valley Anguilla,

More information

St Richard s Hospice Nepal Himalaya Trek and Hospice Project 2 nd 13 th November 2019

St Richard s Hospice Nepal Himalaya Trek and Hospice Project 2 nd 13 th November 2019 St Richard s Hospice Nepal Himalaya Trek and Hospice Project 2 nd 13 th November 2019 Please return this completed form, along with your cheque (if applicable) and passport copy to: Fundraising, St Richard's

More information

Terms & Conditions - Summer Camp

Terms & Conditions - Summer Camp Terms & Conditions - Summer Camp INTRODUCTION These terms and conditions apply to camps organised by International Camp Suisse Limited (Co No 07672923) whose registered office is at Century House 29 Clarendon

More information

Celtic Quilt Tours, LLC.

Celtic Quilt Tours, LLC. , LLC TRAVELER REGISTRATION FORM, LLC. 2019 Quilt Shop and Textile Tour of Ireland Worldwide Quilt & Textile Tours June 3 14, 2019 Kim Caskey (CANADA) Debbi Cagney (USA) kim@kimcaskey.ca; 780-288-9008

More information

Brighter Futures Fundraising Department Trust HQ The Great Western Hospital Marlborough Road Swindon SN3 6BB

Brighter Futures Fundraising Department Trust HQ The Great Western Hospital Marlborough Road Swindon SN3 6BB Brighter Futures Fundraising Department Trust HQ The Great Western Hospital Marlborough Road Swindon SN3 6BB Tel: 01793 605631 Email: Jennifer.Green@gwh.nhs.uk www.gwh.nhs.uk Registered Charity No: 1050892

More information

ALASKA REGISTRATION FORM

ALASKA REGISTRATION FORM ALASKA REGISTRATION FORM Name: E-Mail: _ Trip Name: Starting Date: Number of Days: Mailing Address: Phone Number: Home: Work: Cell: Age Gender Height Weight Waist Shoe Size What are your expectations for

More information

Amateur Station Licence

Amateur Station Licence APPLICATION FORM Amateur Station Licence Document No: ComReg 09/45(a)R1 Date: May 2017 An Coimisiún um Rialáil Cumarsáide Commission for Communications Regulation 1 Dockland Central, Guild Street, Dublin

More information

Thank you for downloading this information.

Thank you for downloading this information. Thank you for downloading this information. For more information, advice or for a free quote, please contact our global head office at the address below who will redirect you to a regional office located

More information

ECE Travel LTD. Standard Terms and Conditions. with

ECE Travel LTD. Standard Terms and Conditions. with ECE Travel LTD Standard Terms and Conditions with The following booking conditions, together with the information set out on the relevant programme itinerary from ECE will form the contract between your

More information

BOOKING FORM TOUR TITLE DEPARTURE DATE. SURNAME (As on passport) FIRST NAME(S) (As on passport) TITLE DATE OF BIRTH KNOWN AS (Preferred name)

BOOKING FORM TOUR TITLE DEPARTURE DATE. SURNAME (As on passport) FIRST NAME(S) (As on passport) TITLE DATE OF BIRTH KNOWN AS (Preferred name) Please complete this form and send it together with your deposit to: Art Tours Ltd, 2 Ordnance Mews, London NW8 6PF PLEASE COMpLETE FORM IN BLOCK CApITALS BOOKING FORM TOUR TITLE DEPARTURE DATE SURNAME

More information

Instruction sheet buy-sell deed

Instruction sheet buy-sell deed Instruction sheet buy-sell deed From: Please phone 07 3233 8856 if you have any queries or require any assistance completing this form #Note: Please print clearly in block letters - errors may incur extra

More information

THE TRINITY ACADEMY ENGLISH COURSE FEES 2017

THE TRINITY ACADEMY ENGLISH COURSE FEES 2017 THE TRINITY ACADEMY ENGLISH COURSE FEES 2017 15 HOURS Just English! Standard ALL LEVELS * Maximum 12 students per class BUSINESS ENGLISH Standard 15hrs/week (AM or PM) Sep - May Sep - May Sep- May Jun-August

More information

Travel Claims Form STEP 1 CLAIM FORM COMPLETION REQUIREMENTS STEP 2 CLAIMANT DETAILS. Policy and Claimant Details. A. Travel Arrangements

Travel Claims Form STEP 1 CLAIM FORM COMPLETION REQUIREMENTS STEP 2 CLAIMANT DETAILS. Policy and Claimant Details. A. Travel Arrangements STEP 1 CLAIM FORM COMPLETION REQUIREMENTS Please complete this form and sign. Please provide further information on a separate sheet if necessary. Failure to disclose all material information and/or misrepresentation

More information

Justin Bieber The O2, London Tuesday 11th October 2016

Justin Bieber The O2, London Tuesday 11th October 2016 Justin Bieber The O2, London Tuesday 11th October 2016 Travel arrangements and times: Please keep this information for future reference. Travel by Minibus. Unless you make arrangements to the contrary,

More information

Wembley Cup Wembley Stadium, London Saturday 7th October

Wembley Cup Wembley Stadium, London Saturday 7th October Wembley Cup Wembley Stadium, London Saturday 7th October Travel arrangements and times: Please keep this information for future reference. Travel by Coach. Unless you make arrangements to the contrary,

More information

Travelearn Participant Form

Travelearn Participant Form Travelearn Participant Form Travelearn Program Faculty Coordinator Name Dates of Program This form must be completed in full, and must be accompanied by the following documents: $150 Administrative Fee

More information

Skydive. Have you got what it takes? Information Pack. Interested? Read on! In association with.

Skydive. Have you got what it takes? Information Pack. Interested? Read on! In association with. Information Pack Skydive Have you got what it takes? Exhilarating 10,000 foot freefall parachute jump No experience required If you raise the minimum sponsorship of 395 you will get to jump for free! Interested?

More information

FACULTY STUDY ABROAD PACKET

FACULTY STUDY ABROAD PACKET FACULTY STUDY ABROAD PACKET This is the official application for the faculty sponsor in charge of a study abroad program at Northeastern State University. Please complete this application in full, including

More information

*** ALL handlers/riders/drivers MUST complete this form *** CONDITIONS OF ENTRY AHSA LIABILITY DECLARATION EVERY HANDLER, RIDER, DRIVER, GROOM & ANYONE HANDLING A HORSE OR PONY MUST COMPLETE THE ARABIAN

More information

Pleasure Craft Proposal

Pleasure Craft Proposal Marine Pleasure Craft Proposal Pleasure Craft Proposal Personal Details Owner s Full Name: Postal Address: (Please complete in block letters) Date of Birth: Telephone No. (daytime): Email (Optional): Names

More information

Be A Paleontologist For A Week!

Be A Paleontologist For A Week! Be A Paleontologist For A Week! Join Science Center staff as we trek to eastern Montana to experience life as a paleontologist! During the week you will prospect for fossils of both dinosaurs and other

More information

CLAIM FORM FOR MEDICAL EXPENSES AND OTHER EXPENSES

CLAIM FORM FOR MEDICAL EXPENSES AND OTHER EXPENSES CLAIM FORM FOR MEDICAL EXPENSES AND OTHER EXPENSES Please note that we have to ensure that our claim form covers all types of claim. If you do not consider a question to be relevant to your circumstances

More information

COMPLETE SOLUTIONS COMPANY PENSION PLAN

COMPLETE SOLUTIONS COMPANY PENSION PLAN PENSIONS INVESTMENTS LIFE INSURANCE COMPLETE SOLUTIONS COMPANY PENSION PLAN APPLICATION DETAILS PLEASE READ THE QUESTIONS CAREFULLY BEFORE ANSWERING THEM AND USE BLOCK CAPITALS. If any item is blank or

More information

AFRICA NEEDS LIONS Sponsored Parachuting

AFRICA NEEDS LIONS Sponsored Parachuting AFRICA NEEDS LIONS Sponsored Parachuting ALERT (UK) 39 St. James s Place London SW1A 1NS United Kingdom T: + 44 (0)20 3371 7835 e: info@lionalert.org w: www.lionalert.org Thank you for your enquiry about

More information

OVERSEAS PROGRAMS STUDENT AGREEMENT

OVERSEAS PROGRAMS STUDENT AGREEMENT OVERSEAS PROGRAMS STUDENT AGREEMENT I, (print or type name of Student), acknowledge that I have voluntarily applied to an overseas study program ( Program ) offered by the Santa Monica Community College

More information

Grosse Pointe Memorial Church 2019 Registration Form 4 th /5 th grade Winter Retreat Camp Michindoh FRIDAY, MARCH 1 - SUNDAY, MARCH 3, 2019

Grosse Pointe Memorial Church 2019 Registration Form 4 th /5 th grade Winter Retreat Camp Michindoh FRIDAY, MARCH 1 - SUNDAY, MARCH 3, 2019 2019 Registration Form 4 th /5 th grade Winter Retreat Camp Michindoh FRIDAY, MARCH 1 - SUNDAY, MARCH 3, 2019 Use the checklist to make sure Registration is complete 2019 Winter Retreat Registration form

More information

Travel to Scotland Registration Form

Travel to Scotland Registration Form Travel to Scotland Registration Form September 21 September 28, 2019 Please download and complete all six pages of this registration form and agreement and retain a copy for your records. One form for

More information

J-1 Internship Program Overview

J-1 Internship Program Overview J-1 Internship Program Overview Welcome to the J-1 Visa information site of International Educational Exchange, Inc. In this section, you will learn more about how to apply for a J-1 visa in the Intern

More information

Avant Travel Insurance Claim Form

Avant Travel Insurance Claim Form Avant Travel Insurance Claim Form Avant Mutual Group Limited ABN 58 123 154 898 Important: please read before you complete this form 1. Please answer all questions and provide all relevant documentation

More information

FORM 1 Trip Itinerary Complete one form for the entire group. Fill all blank spaces or mark N/A if not applicable.*

FORM 1 Trip Itinerary Complete one form for the entire group. Fill all blank spaces or mark N/A if not applicable.* FORM 1 Trip Itinerary Complete one form for the entire group. Fill all blank spaces or mark N/A if not applicable.* Group Purpose of trip Destination/Place Date of departure Estimated time & location Date

More information

Claim Form TRAVEL INSURANCE

Claim Form TRAVEL INSURANCE ACCIDENT & HEALTH INTERNATIONAL Claim Form TRAVEL INSURANCE Sydney Level 4, 33 York Street Sydney NSW 2000 GPO Box 4213, Sydney, NSW, 2001 T: +61 2 9251 8700 F: +61 2 9252 4385 ABN: 26 053 335 952 AFS

More information

Qualification Awarding body Year

Qualification Awarding body Year Application for Registration as an Chartered Tax Adviser (CTA) Student 2017 Personal Details Title: Surname: First Name: Work Telephone Number: Mobile Telephone Number: E-mail (A valid e-mail address is

More information

INTERNATIONAL HARDSHIP FUND APPLICATION FORM

INTERNATIONAL HARDSHIP FUND APPLICATION FORM INTERNATIONAL HARDSHIP FUND APPLICATION FORM This form will be used to assess your eligibility for the International Hardship Fund. Please read the guidance before completing this form. Please answer all

More information

Continuing Education 5.0 CEU hours available by application (additional $25 fee). Submit requests with your application below.

Continuing Education 5.0 CEU hours available by application (additional $25 fee). Submit requests with your application below. and Director of Public Affairs/Alumni Relations Connie Nelson Page 1 of 6 July 16 th (Departure from U.S.) to 27th, 2017 COST $1600.00 per person, twin sharing. Add $700 for a single room Does not include

More information

University of Maryland-Campus Recreation Services MAP Trip Registration Packet

University of Maryland-Campus Recreation Services MAP Trip Registration Packet University of Maryland-Campus Recreation Services MAP Trip Registration Packet Trip Name: Trip Please read the following trip information carefully. Please initial and sign where requested to acknowledge

More information

Galway Summer 2019 Program Application

Galway Summer 2019 Program Application Galway Summer 2019 Program Application Suffolk University Law School 120 Tremont Street Boston, MA 02108-4977 T 617 573-8160 F 617 723-6114 lcove@suffolk.edu APPLICATION INSTRUCTIONS This form (the Program

More information

APPLICATION FORM FOR PUBLIC & PRODUCTS LIABILITY / PROFESSIONAL INDEMNITY INSURANCE

APPLICATION FORM FOR PUBLIC & PRODUCTS LIABILITY / PROFESSIONAL INDEMNITY INSURANCE JLT SPORT COACHES APPLICATION FORM FOR PUBLIC & PRODUCTS LIABILITY / PROFESSIONAL INDEMNITY INSURANCE This proposal is NOT for commercial operators but is for Individual Coaches PLEASE NOTE: This policy

More information

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone:

Registration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone: Registration Form Name: Address: City: State: Zip: School: Grade: Grad Year: GPA: HT: WT: Cell Phone: Email: Size: Shirt: Pants: Helmet: Shoe: Jersey #: (List 3 numbers) Parent/Guardian Information Player

More information

UltraCare Plan Individual & Family Application Form

UltraCare Plan Individual & Family Application Form Pacific Prime International Innovations in International Private Medical Insurance UltraCare Plan Individual & Family Application Form If you have any questions or need any assistance in completing this

More information

ISAs, UNIT TRUSTS, OEICs ISA TRANSFERS APPLICATION FORM. 2018/2019

ISAs, UNIT TRUSTS, OEICs ISA TRANSFERS APPLICATION FORM. 2018/2019 LEGAL & GENERAL (UNIT TRUST MANAGERS) LIMITED ISAs, UNIT TRUSTS, OEICs ISA TRANSFERS APPLICATION FORM. 2018/2019 Please ensure you ve read the current version of the following documents before you make

More information

Original Impulse P.O. Box Denver, CO 80203

Original Impulse P.O. Box Denver, CO 80203 Capture the Wow Registration Form September 7-12, 2017 Welcome to Capture the Paris Wow! I look forward to this creative adventure with you in Paris. In order to secure your place in the retreat, please

More information

Trip Details. Personal Details. Booking Form and Terms and Conditions. In partnership with. Date: 24/11/2015 Page: 1

Trip Details. Personal Details. Booking Form and Terms and Conditions. In partnership with. Date: 24/11/2015 Page: 1 Page: 1 In partnership with Trip Details Travel dates 15-23 Sept 2016 Accommodation required twin rooms and two person tents Special requests Destination Rongai Route, Kilimanjaro Charity trek Marangu

More information

Dear Thrill Seeker, Good luck with raising your sponsorship and we look forward to hearing from you soon. Yours sincerely

Dear Thrill Seeker, Good luck with raising your sponsorship and we look forward to hearing from you soon. Yours sincerely Dear Thrill Seeker, We are looking for people from all over the country to make a sponsored 10,000 feet freefall parachute jump on our behalf and in return we are willing to pay for it! Everything you

More information

Section 2 Applicant Details and Establishment (see Section 2 in the Guide) 2A Name of Applicant. 2B Business Address of Applicant

Section 2 Applicant Details and Establishment (see Section 2 in the Guide) 2A Name of Applicant. 2B Business Address of Applicant ROAD HAULAGE OPERATOR LICENCE APPLICATION FORM This is an application form for a Road Haulage Operator Licence, and for all the appropriate documents for vehicles to be authorised under the licence. Please

More information

ABN (Address) (Suburb, Post Code)

ABN (Address) (Suburb, Post Code) ABN 81 660 358 175 (Name) (Address) (Suburb, Post Code) 25 September 2017 Dear (Name), We are pleased to engage you as a Water Polo Convener with the Association of Heads of Independent Girls Schools NSW

More information

PART 2: Payer s Details PLEASE COMPLETE ALL FIELDS IN BLOCK LETTERS

PART 2: Payer s Details PLEASE COMPLETE ALL FIELDS IN BLOCK LETTERS STUDENT PICTURE CONTACT DETAILS PART 1: Student Details PLEASE COMPLETE ALL FIELDS IN BLOCK LETTERS NB: Full time and Part Time Students to fill in Part 1,2,3,4,5 NB: E-Learning Students to fill in Part

More information

All expedition based on shared accommodation. If prefer single accommodations at an additional cost No Yes

All expedition based on shared accommodation. If prefer single accommodations at an additional cost No Yes MOUNTAIN LEGENDS INC ADDRESS BELLAVISTA MONTUFAR 164 TELFAX 593 9 99811941 QUITO - ECUADOR info@mountainlegendsinc.com/ www.mountainlegendsinc.com PERU EXPEDITION REGISTER FORM Name of Expedition: Full

More information

Club Application Pack 2018 for clubs seeking affiliation to the BMC

Club Application Pack 2018 for clubs seeking affiliation to the BMC Club Application Pack 2018 for clubs seeking affiliation to the BMC First Produced: December 2017 The British Mountaineering Council 177 179 Burton Road, M20 2BB T: 0161 445 6111 E: office@thebmc.co.uk

More information

PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE:

PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE: Spring Break Camp PARENT/GUARDIAN NAME: PARENT/GUARDIAN DOB: (Person responsible for account) CAMPER NAME: CAMPER DOB: GRADE: SHIRT SIZE: Have you attended Camp C-Woo before? Yes No CWU ID Number Spring

More information

EQ TRAVEL CLAIM FORM

EQ TRAVEL CLAIM FORM EQ TRAVEL CLAIM FORM Agency Policy No Please note: Sections 1, 2 and 12 must be completed. Sections 3 to 11 complete only the relevant sections. The acceptance of this form is NOT an admission of liability

More information

CSUB Field Trip Policy

CSUB Field Trip Policy CSUB Field Trip Policy Per the CSU Chancellor s Executive Order No. 715, the following constitutes the Field Trip Policy of California State University, Bakersfield (CSUB). For the purposes of this policy,

More information

OCA Skydive Day. Take Off and Take Action. Enquiry Pack

OCA Skydive Day. Take Off and Take Action. Enquiry Pack OCA Skydive Day Take Off and Take Action Enquiry Pack OCA Skydive Day 5 th September 2015 Thank you for enquiring about the OCA Skydive Day On 5 th September 20 jumpers will participate in the challenge

More information

TERMS and CONDITIONS

TERMS and CONDITIONS Jack Graham Photography Workshops, Fuji X Photo Workshops & Ultimate Photo Workshops REGISTRATION & ACKNOWLEDGE of RISK FORMS Including TERMS and CONDITIONS Jack s Website Jack s Blog Email: jack@jackgrahamphoto.com

More information

710.%$ %89-1 +!!0 /9., ! " # $% $& ' (

710.%$ %89-1 +!!0 /9., !  # $% $& ' ( %5 6$6 710.%$ %89-1 +0 /9., # $% $& ' ( 3 '. 14 ' ) * *+, 2 5 -,./ 0 1-2 /01& #$ $%&% $ $ #$%&' (%$)& * +, - #./ )# - 0( Registration form 1. Personal details 2. Course Family name: First name: Title:

More information

Ceylon Express International

Ceylon Express International Ceylon Express International 9542 Dumbreck Drive, Huntington Beach, CA 92646, USA Tel: 714-964 6896 - Fax: 714 968-4296 E- Mail: tours@ceylonexpress.com - Web: www.ceylonexpress.com WITIA REGISTRATION

More information

2015 ULTIMATE ICELAND REGISTRATION FORM(2 pages) Jack Graham Photography Workshops

2015 ULTIMATE ICELAND REGISTRATION FORM(2 pages) Jack Graham Photography Workshops 2015 ULTIMATE ICELAND REGISTRATION FORM(2 pages) Jack Graham Photography Workshops WORKSHOP DATE REQUIRED INFORMATION Name Home Phone Cell Phone Address Emergency Contact Email Website/blog Age Please

More information

ALL THAT S LEFT TO DO NOW IS TAKE THE LEAP!

ALL THAT S LEFT TO DO NOW IS TAKE THE LEAP! A tandem skydive is the most popular and frequently chosen type of jump by novice and first time thrill-seekers you don t need any previous experience at all to do this jump! For this particular skydive

More information

COMPLETE SOLUTIONS PRSA / PRSA AVC APPLICATION DETAILS

COMPLETE SOLUTIONS PRSA / PRSA AVC APPLICATION DETAILS PENSIONS INVESTMENTS LIFE INSURANCE COMPLETE SOLUTIONS PRSA / PRSA AVC APPLICATION DETAILS Before you give us your personal information please note that Irish Life has a Data Privacy Notice. This explains

More information

2.Bentley Handicap (pit lane start) 15 Mins (i). Bentley Open Race 3(ii). Allcomers Scratch Race. (i) 215 B FISCAR 30 Mins

2.Bentley Handicap (pit lane start) 15 Mins (i). Bentley Open Race 3(ii). Allcomers Scratch Race. (i) 215 B FISCAR 30 Mins Bentley Drivers Club Silverstone Race Meeting 4 th August 2018 MSA Permit No, Clubmans:TBA No, Nat B: TBA ENTRY FORM Held under the General Regulations of The Motor Sports Association (incorporating the

More information

Application for registration of a Limited Partnership Limited Partnerships Act 2008

Application for registration of a Limited Partnership Limited Partnerships Act 2008 Page 1 of 9 Version October 2017 www.limitedpartnerships.govt.nz 0508 266 726 Post your completed form to: National Processing Centre, Private Bag 92061, Victoria Street West, Auckland 1142 Application

More information

OTTAWA FULL TIME ACADEMY APPLICATION Page 1 of

OTTAWA FULL TIME ACADEMY APPLICATION Page 1 of OTTAWA FULL TIME ACADEMY APPLICATION Page 1 of 8 REGISTRATION FORMS MUST BE COMPLETED ACCURATELY AND IN THEIR ENTIRETY TO ENSURE A SPOT IS RESERVED FOR YOUR CHILD. PLEASE ENSURE ALL SECTIONS ARE FILLED

More information

ASSUMPTION COLLEGE ROME PROGRAM APPLICATION

ASSUMPTION COLLEGE ROME PROGRAM APPLICATION ASSUMPTION COLLEGE ROME PROGRAM APPLICATION APPLICATION CHECKLIST Applications will be considered complete and ready for review when the following documents have been submitted by the deadline. Students

More information

Location of IIT Start date (MONTH) Start date (DAY) Start date (YEAR)

Location of IIT Start date (MONTH) Start date (DAY) Start date (YEAR) 2011 International Intensive Training (IIT) Program Application The Center for Nonviolent Communication 5600 San Francisco Road NE, Suite A Albuquerque, NM 87109 U.S.A. Tel: +1 505 244 4041 (toll free

More information

INTRODUCTION TO MARTIAL ARTS INSURANCE

INTRODUCTION TO MARTIAL ARTS INSURANCE Dear Instructor, INTRODUCTION TO MARTIAL ARTS INSURANCE Thank you for considering our group martial arts insurance packages and other services. This page gives you a quick overview of the types of insurance

More information

INESLE - Spanish Summer Program in Madrid - SPAIN

INESLE - Spanish Summer Program in Madrid - SPAIN INESLE - Spanish Summer Program in Madrid - SPAIN TERMS AND CONDITIONS - Form 0 Student Name: Gender: M F Date of Birth: / / Social Security Number: Month/Day/Year Home Address: Street and Apt Number City

More information

Wireless Public Address System (WPAS) Licence

Wireless Public Address System (WPAS) Licence APPLICATION FORM Wireless Public Address System (WPAS) Licence Document No: ComReg 06/26a Date: 22 June 2006 An Coimisiún um Rialáil Cumarsáide Commission for Communications Regulation Abbey Court Irish

More information

Gravity Terms and Conditions Terms and Conditions

Gravity Terms and Conditions Terms and Conditions Gravity Terms and Conditions Terms and Conditions It would take on average 76 work days (8 hours a day) to read the terms and conditions that they agree to in a year. That might be true. I read it in a

More information

Aviva Executive Pension Policy Application Form

Aviva Executive Pension Policy Application Form Aviva Executive Pension Policy Application Form to Aviva Life & Pensions UK Limited ( Aviva ) Please note carefully This is a legal document and together with the policy conditions (which are available

More information

2019 Nashville Pilot Camp Registration

2019 Nashville Pilot Camp Registration 2019 Nashville Pilot Camp Registration Camp Information The following pages contain the registration form, code of conduct, and all medical paperwork to be filled out. Be sure to fill these out and mail,

More information

INTERNATIONAL PASSENGER PROTECTION LTD IPP House, Station Rd, West Wickham, Kent, BR4 0PR Tel: / Fax:

INTERNATIONAL PASSENGER PROTECTION LTD IPP House, Station Rd, West Wickham, Kent, BR4 0PR Tel: / Fax: 2438 INTERNATIONAL PASSENGER PROTECTION LTD IPP House, 22-26 Station Rd, West Wickham, Kent, BR4 0PR Tel: 020 8776 3752 / Fax: 020 8776 3751 FINANCIAL FAILURE OF TOUR ORGANISER CLAIM FORM Name: Address:

More information

Oldfeld International Boarding School Conditions of Acceptance of Enrolment

Oldfeld International Boarding School Conditions of Acceptance of Enrolment Conditions of acceptance of enrolment Oldfeld International Boarding School Conditions of Acceptance of Enrolment All enrolments are subject to these conditions and become legally binding on confirmation

More information

AeroCamp 2015 Camp Information

AeroCamp 2015 Camp Information AeroCamp 2015 Camp Information Old Bridge Flight School is offering Aviation Camp (AeroCamp) for children ages 10 through 18. The program will run from Monday July 6 through Friday July 10, 2015, 09:00

More information

CHICO STATE FACULTY-LED STUDY ABROAD PROGRAM TANZANIA, SUMMER 2016 PROGRAM APPLICATION

CHICO STATE FACULTY-LED STUDY ABROAD PROGRAM TANZANIA, SUMMER 2016 PROGRAM APPLICATION CHICO STATE FACULTY-LED STUDY ABROAD PROGRAM TANZANIA, SUMMER 2016 PROGRAM APPLICATION 530-898-6105 RCE@CSUCHICO.EDU RCE.CSUCHICO.EDU/PASSPORT/TANZANIA2016 PROGRAM APPLICATION IMPORTANT DATES: April 11,

More information

TRAVEL CLAIM FORM THIS FORM SHOULD BE COMPLETED AND RETURNED TO:

TRAVEL CLAIM FORM THIS FORM SHOULD BE COMPLETED AND RETURNED TO: TRAVEL CLAIM FORM THIS FORM SHOULD BE COMPLETED AND RETURNED TO: Echelon Claims Services - GPO Box 1693, Adelaide SA 5001 Email: ecssa@echelonaustralia.com.au Phone: 08 8235 6455 or Free call 1800 640

More information

TEXAS A&M INTERNATIONAL UNIVERSITY

TEXAS A&M INTERNATIONAL UNIVERSITY AGREEMENT FOR WAIVER, INDEMNIFICATION, ASSUMPTION OF RISK AND MEDICAL TREATMENT AUTHORIZATION I,, age, desire to participate voluntarily in all activities of the ( Activity ), which is sponsored or conducted

More information

Single Will Instruction Form

Single Will Instruction Form Single Will Instruction Form Please read the associated Will guidance notes before completing this form. If you require any assistance when completing this form please call our Customer Care Team on 0808

More information