FOOTPLATE EXPERIENCE BOOKING FORM

Person Making the Booking:-

Name

Address

Post Code Email

Telephone Numbers (Day) (Evening)

Name of Participant:-

Name

Address

Post Code Email

Telephone Numbers (Day) (Evening)

If being presented as a gift, please indicate the date of the presentation, so that we can contact the recipient after that date.

Prices - £250 (steam); £225 (diesel).

Please book place(s) on the steam/diesel course @ £250 £225 each

on (date) or an Open dated voucher (please tick).

Please charge £ to my Credit/Debit card.

Visa Delta MasterCard Switch

Card Number Issue No (Switch)

Card Start Date / Expiry Date / Security Code (back of card)

Card holder's name (as shown on the card) Date

N.B. This site is not yet SSL rated. It is therefore recommended that you either print this form or download the pdf version of the form and then send your booking by fax or post.