Registration Form - Walk the Test Way - Sponsored Walk 12/10/2008

REGISTRATION FORM

Neville Taylor Walk Event Registration Officer Rotary Club of Romsey Test Keepers Cottage, Jermyns Lane Ampfield, Romsey SO51 6AR I hereby confirm that I wish to take part in "Walk the Test Way" on Sunday 12^th October 2008. I agree to pay £5.00 to the "Rotary Club of Romsey Test". I confirm that I will raise sponsorship in support of the charity I specify below. I will collect and forward these to the Rotary Club within 3 weeks after the event. It is accepted that I participate in the walk of my own free choice and do so entirely at my own risk. I also confirm that the Rotary Club of Romsey Test are not liable in the event of any accident. Please fill in the form below and then Click Send /Submit button at the bottom of the page:
		* Boxes marked with an asterisk must be filled in
Title:		*
Forename:		*
Surname:		*
Address 1:		*
Address 2:
Town:
County:
Post Code:		*
Telephone:
Mobile:
Email
Which Charity:		* Please enter your charity below:
		Detail of Other Charity (if appropriate):

Are you over 14 on the 8 Oct 2006:		* If NO please ask a parent/guardian to fill the part below in:
As the parent/guardian, please state your name and confirm that you hereby agree with the above details and also to the above named participating in the Walk:		Parent/Guardian Name:
		Name of accompanying adult - who must also register separately:
		Parent/Guardian Agree:

Do you have any medical condition or disabilities that we should be aware of (please give details)?

I wish to start my walk from:		*

Where did you hear about the walk?		*
		Details where heard (if appropriate):
Any other points you would like to make:


Rotary Club of Romsey Test is a Registered Charity - No: 1029525
	Rotary Club Of Romsey Test
Level 07-2