COURSE BOOKING FORM

Plas y Brenin

Capel Curig

Betws-y-Coed

LL24 0ET

01690 720 214
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.
COURSE BOOKING FORM
Customer Details:
Full Name*

First NameLast Name
Date of Birth

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
E-mail*
example@example.com
Special Dietary Requirements
Medical Condition, Allergies or Significant Disabilities
Details of Emergency Contact *

NameTelephone Number
Course Details
Course Title:*
Course Start Date*

DayMonthYear
Select Course Package*
Mountain Training/British Cycling Registration No. (If Applicable)
Fees
Do you have a PYB Membership?*
Who is Paying Your Invoice*
The balance of your course fee is due 10 weeks before the start of your course.
The full fee of my course is
£
Please select Payment:*
Please Select Payment Method:*
If a third party is paying your balance, please ensure you input all of the following fields correctly:
PURCHASE ORDER NUMBER

INVOICING EMAIL ADDRESS

INVOICING ADDRESS

CITYState / Province

POSTCODE
I have read and understood the terms and conditions relating to this booking, inparticular those concerning cancellation. I understand that bookings are accepted on the understanding that Plas yBrenin 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 occur.
Signature*

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Date*

DayMonthYear
Date
Should be Empty:

COURSE BOOKING FORM

Course Details

Fees