Training / Assessment weekends

(Dates)

Training / Assessment week

(Dates)

Mr. Mrs. Miss. (other) ___________Surname _____________________________

Forenames _________________________________________________________

Address _________________________________________________________

_________________________________________________________

_________________________________ Post Code _______________

Day Phone ________________________ Evening Phone ____________________

Email: _________________________________________________________

EXPERIENCE ( Boating experience with number of days in the last 5 years, times of year, weather conditions, routes etc leading/assisting groups, hours at helm and so on, any qualifications? - boating, leadership, first aid etc. If none to any of these questions please state none!)

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

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I enclose course fee of £ __________ Please make cheques payable to: LNBP

Signed ______________________________ Date _________________________