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1.
Printable application form:
RIDGEWAY AND VALE DIABETES EXPEDITIONS –
MEMBERSHIP FORM
Mr/Mrs/Ms/Dr:
Qualifications:
Full Name:
Home Address:
Post Code:
Home ‘Phone Number:
Business/Office Phone Number:
Mobile ‘Phone:
Email Address:
Signed:
Date:
Please send this membership form with a cheque for £ 12.50p for your subscription
to:
The Hon Secretary, Ridgeway and Vale Diabetes Expeditions, c/o 23, Dunton Road, Stewkley, Leighton Buzzard,
Beds. LU 7 0 HY.
Please make out your cheque to “Ridgeway and Vale Diabetes
Expeditions”.
Data Protection: Ridgeway and Vale Diabetes Expeditions undertakes to hold these details
and to use them only for purposes associated with the organisation of walks and such other purposes as may be agreed from
time to time by the Committee. Details will not be passed to outside parties without the agreement of the individual concerned.
RIDGEWAY AND VALE
DIABETES EXPEDITIONS
THE 2010 EXPEDITION –
THE COAST TO COAST WALK FIRST 65 MILES SATURDAY 11th. – SATURDAY
18th. SEPTEMBER.
BOOKING FORM - Please put my name down for this expedition.
The charge to walkers for the Expedition is £ 250. This covers accommodation,
insurance, food and some travel costs. Please include a £ 50 deposit with this form when you return
it. If you have to withdraw before the Briefing Day, the deposit will be returned to you.
Please make out your cheque to “Ridgeway and Vale Diabetes Expeditions” and
please try to send it by the end of June. You will be sent an acknowledgement and the details of the Briefing Day and the
Expedition in due course, as well as a Medical Declaration.
If you know of a diabetic friend who might benefit from joining
the Expedition, please copy this form and suggest they complete and send it in. If you are newly diagnosed you will be particularly welcome – even if you have little walking experience -
most of us will have been through it once! Please
return this form as soon as possible to me at the address given below or hand ittto me at the Bookings will be on the “First Come
– First Served” principle but priority will be given to diabetic patients.
Name:
Qualifications:
Address:
Post Code:
Home ‘Phone:
Work ‘Phone:
Mobile:
Email:
I
am prepared to act as a volunteer medical supporter:
Signed……………………….
Date:………………………
Please Return to: Ingram Murray, Ridgeway and Vale Diabetes Expeditions, 23, Dunton Road, Stewkley, Leighton Buzzard, Beds., LU 7 0 HY. (Electronic copies are acceptable, providing
the deposit follows by mail)
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