ABSEIL ENTRY FORM

2nd June 2012 Miller House, Maidstone

Thank you for registering to take part in our abseil, it is a fantastic challenge that you will not regret! Please complete your details below and either email to Abseil@AshfordRT353.org.uk.
Or post to

Ashford Round Table 353, C/O 26 George Gurr Crescent, Folkestone, Kent. CT19 6LQ Forename: ____________________________________ Surname: ____________________________________ Address: ____________________________________ ____________________________________ Post code: ____________________________________
Please indicate if you are participating as an individual, small group or company team ___________________________. Please indicate your preferred start time (abseils will be held throughout the day 9am 4pm) _____________________. You will be required to raise a minimum of 100 in sponsorship and pay a registration fee of 20

Telephone: _____________________________________ Email address: _____________________________________ Company name: _____________________________________ Date of birth: _____________________________________

I declare that I will be 18 years or over on 2nd June 2012 and I agree to take part in this event at my own risk. To the extent permitted by law, neither Ashford & District Round Table 353 nor its sponsors, contractors suppliers and agents be liable for any loss, damage, death, illness or injury whatsoever directly or indirectly occasioned by or resulting from this event. Ashford & District Round Table 353 reserves the right to alter the date or timings of the event I am not aware of any medical condition or any other reason why I should not participate in this event. Signature Date

I enclose my registration fee* by cash/cheque. Cheques should be made payable to Ashford & District Round Table Signed ___________________________________________ Date: ____________________
* I understand this is non-refundable and does not count towards the final sponsorship amount raised