Customer Booking Form (on Website)

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.
CHOSEN DETAILS:
TITLE OF COURSE
COURSE START DATE

DayMonthYear
Date
PLEASE CHOOSE BETWEEN THE FOLLOWING:
Amount of Attendees:
Mountain Training/British Cycling Number (If Applicable)
PERSONAL DETAILS:
LEAD BOOKER

First NameLast Name
DATE OF BIRTH

DayMonthYear
Date
ADDRESS
POSTCODE
TELEPHONE
EMAIL
example@example.com
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
In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
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
ATTENDEE #2 PERSONAL DETAILS:
ATTENDEE #2

First NameLast Name
ATTENDEE #2 DATE OF BIRTH

DayMonthYear
Date
ATTENDEE #2 ADDRESS
ATTENDEE #2 POSTCODE
ATTENDEE #2 TELEPHONE
ATTENDEE #2 EMAIL
example@example.com
ATTENDEE #2 MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
ATTENDEE #2 AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ATTENDEE #2 ADDITIONAL BOOKING DETAILS:
ATTENDEE #2 SPECIAL DIETARY REQUIREMENTS
ATTENDEE #2 MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS
ATTENDEE #2 In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
ATTENDEE #2 I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
ATTENDEE #2 NAME OF EMERGENCY CONTACT
ATTENDEE #2 PHONE NUMBER OF EMERGENCY CONTACT
ATTENDEE #3 PERSONAL DETAILS:
ATTENDEE #3

First NameLast Name
ATTENDEE #3 DATE OF BIRTH

DayMonthYear
Date
ATTENDEE #3 ADDRESS
ATTENDEE #3 POSTCODE
ATTENDEE #3 TELEPHONE
ATTENDEE #3 EMAIL
example@example.com
ATTENDEE #3 MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
ATTENDEE #3 AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ATTENDEE #3ADDITIONAL BOOKING DETAILS:
ATTENDEE #3 SPECIAL DIETARY REQUIREMENTS
ATTENDEE #3 MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS
ATTENDEE #3 In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
ATTENDEE #3 I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
ATTENDEE #3 NAME OF EMERGENCY CONTACT
ATTENDEE #3 PHONE NUMBER OF EMERGENCY CONTACT
ATTENDEE #4 PERSONAL DETAILS:
ATTENDEE #4

First NameLast Name
ATTENDEE #4 DATE OF BIRTH

DayMonthYear
Date
ATTENDEE #4 ADDRESS
ATTENDEE #4 POSTCODE
ATTENDEE #4 TELEPHONE
ATTENDEE #4 EMAIL
example@example.com
ATTENDEE #4 MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
ATTENDEE #4 AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ATTENDEE #4 ADDITIONAL BOOKING DETAILS:
ATTENDEE #4 SPECIAL DIETARY REQUIREMENTS
ATTENDEE #4 MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS
ATTENDEE #4 In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
ATTENDEE #4 I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
ATTENDEE #4 NAME OF EMERGENCY CONTACT
ATTENDEE #4 PHONE NUMBER OF EMERGENCY CONTACT
ATTENDEE #5 PERSONAL DETAILS:
ATTENDEE #5

First NameLast Name
ATTENDEE #5 DATE OF BIRTH

DayMonthYear
Date
ATTENDEE #5 ADDRESS
ATTENDEE #5 POSTCODE
ATTENDEE #5 TELEPHONE
ATTENDEE #5 EMAIL
example@example.com
ATTENDEE #5 MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
ATTENDEE #5 AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ATTENDEE #5 ADDITIONAL BOOKING DETAILS:
ATTENDEE #5 SPECIAL DIETARY REQUIREMENTS
ATTENDEE #5 MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS
ATTENDEE #5 In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
ATTENDEE #5 I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
ATTENDEE #5 NAME OF EMERGENCY CONTACT
ATTENDEE #5 PHONE NUMBER OF EMERGENCY CONTACT
ATTENDEE #6 PERSONAL DETAILS:
ATTENDEE #6

First NameLast Name
ATTENDEE #6 DATE OF BIRTH

DayMonthYear
Date
ATTENDEE #6 ADDRESS
ATTENDEE #6 POSTCODE
ATTENDEE #6 TELEPHONE
ATTENDEE #6 EMAIL
example@example.com
ATTENDEE #6 MOUNTAIN TRAINING/BRITISH CYCLING REGISTRATION NO. (IF APPLICABLE):
ATTENDEE #6 AWARDS & PAST EXPERIENCE OF CHOSEN ACTIVITY
ATTENDEE #6 ADDITIONAL BOOKING DETAILS:
ATTENDEE #6 SPECIAL DIETARY REQUIREMENTS
ATTENDEE #6 MEDICAL CONDITIONS, ALLERGIES, OR ADDITIONAL NEEDS
ATTENDEE #6 In the Unlikely Event of an Evacuation Do You Require Any Assistance?:
ATTENDEE #6 I WISH TO SHARE A ROOM WITH:
(We try to meet these requests but can not guarantee to do so)
ATTENDEE #6 NAME OF EMERGENCY CONTACT
ATTENDEE #6 PHONE NUMBER OF EMERGENCY CONTACT
PAYMENT
The balance of your course fee is due 10 weeks before the start of your course.
The full fee of my course is £blanks
I am paying...
Select Payment Method
NOTES i.e. discount code:
Do you have a PYB Membership
Please tick the relevant box:

Other
Discount Code?
Please type your offer code in the box above.
Total payment
We recommend that you take out insurance including cancellation insurance.
INVOICING ADDRESS

PURCHASE ORDER NUMBER

INVOICING EMAIL ADDRESS

BUILDING NUMBER/NAMECITY

POSTCODE
NOTES:
Additional information
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)
BOOKING DATE

MonthDayYear
Date
I HAVE READ AND UNDERSTOOD THE TERMS AND CONDITIONS THAT RELATE TO THIS BOOKING.
SIGNATURE
Should be Empty:

CHOSEN DETAILS:

PERSONAL DETAILS:

ADDITIONAL BOOKING DETAILS:

ATTENDEE #2 PERSONAL DETAILS:

ATTENDEE #2 ADDITIONAL BOOKING DETAILS:

ATTENDEE #3 PERSONAL DETAILS:

ATTENDEE #3ADDITIONAL BOOKING DETAILS:

ATTENDEE #4 PERSONAL DETAILS:

ATTENDEE #4 ADDITIONAL BOOKING DETAILS:

ATTENDEE #5 PERSONAL DETAILS:

ATTENDEE #5 ADDITIONAL BOOKING DETAILS:

ATTENDEE #6 PERSONAL DETAILS:

ATTENDEE #6 ADDITIONAL BOOKING DETAILS:

PAYMENT