Plas y Brenin Booking Form
*** Please Note: When paying online the entire course fee is payable immediately. ***
If you would like to pay a deposit you must download a PDF booking form and send it (with a cheque enclosed) by post to Plas y Brenin

Title
*
First Name
 *
Surname
*
Age
*
Date of Birth
(dd/mm/yy) *
**** Fields marked with an asterix must be completed ****
Occupation
Address
*
City
 *
County
 *
Postcode
 *
Contact Telephone numbers
Evening
*
Daytime
 *
Mobile
 *
E-mail
 *
 
Please do not send detailed course notes by post - I will access them from the website
Special Dietary Requirements
*
Medical Conditions
*
I wish to share a room with
Awards and past experience of chosen activity
*
MLTUK/MLTE/MLTNI/MLTS/MLTW/Registration number (if applicable)
 
Name and contact number of a person we can contact in the event of an emergency.
Name:
 *
Tel:
*

Course Fee
First Choice Date
*
Second Choice Date
* (if first choice date is unavailable)
Course Cost
£ 0.00
*** Please Note: When paying online the entire course fee is payable immediately. ***
Optional Insurance Cost
£48.75 
Total Amount Payable
£
 
Additional Comments:
Please tick to confirm that your have read and fully understood our terms and conditions.
I have read and fully understand the terms and conditions of booking and the implications of cancellation.
 



Your Booking Reference is: FAS01-51890

(The Bookings Office is open 9am - 5pm 7 days a week. Telephone: 01690 720214)