The Midnight Walk 2012

Cardholder details:

Full Name:  
Address:  
Postcode: 
Country:  
   Entry Fee £:     The entry fee is £15.00 per person. (non refundable)
Home phone:  
email address:  
The Cardholder and the Walker are the same person
Cardholder and Walker are not the same person

Walkers details:

Please complete all blank fields:  
Title:  
Full Name:  
Address:  
Postcode: 
Telephone:  
Mobile:  
   E-mail address: 
   Date of birth:    in format DD/MM/YYYY
   T Shirt size:  small   medium   large   extra large    
   I would like to walk the:    7 mile route
  10 mile route
   How did you hear about the walk? 
   Please let us know if you have any special reason for walking:  
I confirm I have read the Rules of Entry
I know someone who can volunteer on the night. Please send me further information