BOOKING FORM

BEGINNER AWARD UMPIRING COURSE

Chippenham Sports Club, Hardenhuish Park, Bristol Road, Chippenham, SN15 1NG

SUNDAY 6th JANUARY 2013 COST: £30 Affiliated Members / £40 Non Members

Cheques made payable to ‘Wiltshire County Netball Association’

TIME: 10.00am - 4.00pm (WORKING LUNCH)

NAME: ............................................................................................................................

ADDRESS: .......................................................................................................................

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EMAIL:.............................................................................................................................

TEL……….............................................MOBILE……...........................................................

Emergency Contact Name: …………………………………………………..……………………………………

Emergency Contact No: ……………………………………………………………………………….………...…

Medical Information (e.g. epilepsy, asthma, diabetes, allergies etc.) ……………………….

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Affiliation Number / Netball ID No: (if applicable) ……………….…………………………………This information is essential if you wish to receive the lower affiliated course rate. (Please contact Membership Dept. on 01462 442344 if you have any queries relating to affiliation).

PLEASE RETURN TO:Sophie Warner

Wiltshire Netball Development OfficerWiltshire & Swindon Sport CIC

48 New Park Street, Devizes, Wiltshire, SN10 1DS