Customer Booking Form

CUSTOMER BOOKING FORM

This form should only be used to book a course and date advertised via our website www.pyb.co.uk and where online booking is not possible.Please use one form per person per course. Once complete you will recieve and automatic notification of your submission. Please get in touch if this does not come through.
PERSONAL DETAILS:
FULL NAME*

First NameLast Name
DATE OF BIRTH*

DayMonthYear
Date
ADDRESS*
POSTCODE*
TELEPHONE*
EMAIL*
example@example.com
CHOSEN COURSE:
TITLE OF COURSE/EVENT
COURSE START DATE

DayMonthYear
Date
PLEASE CHOOSE BETWEEN THE FOLLOWING:*

RESIDENTIALNON RESIDENTIAL
MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ADDITIONAL BOOKING DETAILS:
SPECIAL DIETARY REQUIREMENTS*
MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS*
I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
NAME OF EMERGENCY CONTACT*
PHONE NUMBER OF EMERGENCY CONTACT*
PAYMENT
I am paying...

Full Course Fee (If booking is within 6 weeks)25% deposit (non-refundable)Full Event Fee
Please tick the relevant box:*

BY DEBIT/CREDIT CARD - On completion of this form, one of our team will contact you to take paymentBY BANK TRANSFER (BACS) - On receipt of the form our bank details will be emailed to youBY PURCHASE ORDER - For courses more than 6 weeks away please complete and return the booking form with a purchase order for the full amount.Other
Discount Code?
Please type your offer code in the box above.
Total payment*
We recommend that you take out insurance including cancellation insurance.
Would you like to receive offers, updates, info and more from us at PYB? (Don't worry we will not share your info with external/associated companies)*

Yes PleaseNo Thank you
I have read and understood the terms and conditions relating to this booking, in particular those concerning cancellation.

I understand that bookings are accepted on the understanding that Plas y Brenin Safety regulations are observed.

I accept that Plas y Brenin, is not under any liability whatsoever in respect of loss or damage to personal property, not caused by the negligence or default of Plas y Brenin, its suppliers, its agents and employees whilst attending the course.

Participation in adventurous activities entails some risk of injury. Plas y Brenin staff are trained and appropriately qualified to run activity sessions and will at all times proceed in a manner to limit the risk of injury. However participants accept that accidents and injury may
BOOKING DATE*

MonthDayYear
Date
SIGNATURE*

Clear
Should be Empty:

CUSTOMER BOOKING FORM

PERSONAL DETAILS:

CHOSEN COURSE:

ADDITIONAL BOOKING DETAILS:

PAYMENT